Plan Budget Healthcare PDF

‘How to Manage’ Series for Healthcare Technology
Guide 2
How to Plan and Budget for your

Healthcare Technology
by:
Caroline Temple-Bird
Healthcare Technology Management Consultant,
Ziken International Consultants Ltd, Lewes, UK
Willi Kawohl
Financial Management Consultant, FAKT, Stuttgart, Germany
Andreas Lenel
Health Economist Consultant, FAKT, Stuttgart, Germany
Manjit Kaur
Development Officer, ECHO International Health Services, Coulsdon, UK
Series Editor
Caroline Temple-Bird
Healthcare Technology Management Consultant,
Ziken International Consultants Ltd, Lewes, UK
Contents
CONTENTS
Section Page
Foreword i
Preface i
Acknowledgements iii
Abbreviations v
List of Boxes and Figures vii
1. Introduction 1
1.1 Introduction to the Series of Guides 1
1.2 Introduction to this Specific Guide 9
2. Framework Requirements 23
2.1 Framework Requirements for Quality Health Services 24
2.2 Background Conditions Specific to this Guide 33
3. How to Discover your Starting Point – Planning Tools I 41

3.1 The Equipment Inventory 42
3.1.1 Understanding Inventories 42
3.1.2 Establishing the Equipment Inventory 46
3.1.3 Establishing Inventory Code Numbers 50
3.2 Stock Value Estimates 53
3.3 Budget Lines for Equipment Expenditures 57
3.4 Usage Rates for Equipment-related Consumable Items 61
4. How to Find Out Where You are Headed – Planning Tools II 65

4.1 Reference Materials 66
4.2 Developing the Vision of Service Delivery for Each Facility Type 68
4.3 Model Equipment Lists 73
4.4 Purchasing, Donations, Replacement, and Disposal Policies 79
4.4.1 General Issues 79
4.4.2 Purchasing and Donations Policies 80
4.4.3 Replacement and Disposal Policies 85
4.5 Generic Equipment Specifications and Technical Data 87
5. How to Make Capital Budget Calculations

– Budgeting Tools I 99
5.1 Replacing Equipment 101
Contents
5.2 Purchasing New Equipment 106

5.3 Pre-Installation Costs 111
5.4 Support Activities to Enable You to Use Your
Purchases and Donations 116
5.4.1 Installation and Commissioning Costs 118
5.4.2 Initial Training Costs 122
5.5 Large-scale Major Rehabilitation Projects 127
6. How to Make Recurrent Budget Calculations

– Budgeting Tools II 133
6.1 Maintenance Costs 134
6.2 Consumable Operating Costs 144
6.3 Administrative Costs 153
6.4 Ongoing Training Costs 156
7. How to Use the Tools to Make Long-term Equipment Plans

and Budgets 161
7.1 Equipment Development Plan 162
7.2 Equipment Training Plan 172
7.3 Equipment Budget – Financial Plans 180
7.3.1 Core Equipment Expenditure Plan 180
7.3.2 Core Equipment Financing Plan 185
8. How to Undertake Annual Planning, Budgeting,

and Monitoring 191
8.1 Annual Equipment Planning and Budgeting (Setting Goals) 192
8.2 Monitoring Progress 206
8.2.1 How to Monitor Progress Against Annual Equipment Plans
and Budgets 209
8.2.2 How to Monitor Progress in General 215
Annexes 219
1. Glossary 219
2. Reference Materials and Contacts 224
3. Typical Equipment Lifetimes 255
4. Sample Long Generic Equipment Specification 270
5. Sample Technical and Environmental Data Sheet 277
6. Shortcut Planning and Budgeting When Starting Out 279
7. Source Material/Bibliography 281
Foreword
Foreword
This Series of Guides is the output from a project funded by the UK government’s
Department for International Development (DFID) for the benefit of developing
countries. The output is the result of an international collaboration that
brought together:
◆ researchers from Ziken International and ECHO International Health Services in
the UK, and FAKT in Germany
◆ an advisory group from WHO, PAHO, GTZ, the Swiss Tropical Institute, and the
Medical Research Council of South Africa
◆ reviewers from many countries in the developing world
in order to identify best practice in the field of healthcare technology management.
The views expressed are not necessarily those of DFID or the other
organizations involved.
Garth Singleton
Manager, Ziken International Consultants Ltd, Lewes, UK
Preface
The provision of equitable, quality and efficient healthcare requires an extraordinary
array of properly balanced and managed resource inputs. Physical resources such as
fixed assets and consumables, often described as healthcare technology, are among
the principal types of those inputs. Technology is the platform on which the delivery
of healthcare rests, and the basis for provision of all health interventions. Technology
generation, acquisition and utilization require massive investment, and related
decisions must be made carefully to ensure the best match between the supply of
technology and health system needs, the appropriate balance between capital and
recurrent costs, and the capacity to manage technology throughout its life.
Healthcare technology has become an increasingly visible policy issue, and healthcare
technology management (HTM) strategies have repeatedly come under the spotlight
in recent years. While the need for improved HTM practice has long been recognized
and addressed at numerous international forums, health facilities in many countries
are still burdened with many problems, including non-functioning medical equipment
as a result of factors such as inadequate planning, inappropriate procurement, poorly
organized and managed healthcare technical services, and a shortage of skilled
personnel. The situation is similar for other health system physical assets such as
buildings, plant and machinery, furniture and fixtures, communication and information
systems, catering and laundry equipment, waste disposal, and vehicles.
i
Preface
Preface (continued)
The (mis-)management of physical assets impacts on the quality, efficiency and
sustainability of health services at all levels, be it in a tertiary hospital setting with
sophisticated life-support equipment, or at the primary healthcare level where simple
equipment is needed for effective diagnosis and safe treatment of patients. What is
vital – at all levels and at all times – is a critical mass of affordable, appropriate, and
properly functioning equipment used and applied correctly by competent personnel,
with minimal risk to their patients and to themselves. Clear policy, technical
guidance, and practical tools are needed for effective and efficient management of
healthcare technology for it to impact on priority health problems and the health
system's capacity to adequately respond to health needs and expectations.
This Series of Guides aims to promote better management of healthcare technology

and to provide practical advice on all aspects of its acquisition and utilization, as well
as on the organization and financing of healthcare technical services that can deliver
effective HTM.
The Guides – individually and collectively – have been written in a way that makes
them generally applicable, at all levels of health service delivery, for all types of
healthcare provider organizations and encompassing the roles of health workers and
all relevant support personnel.
It is hoped that these Guides will be widely used in collaboration with all appropriate
stakeholders and as part of broader HTM capacity-building initiatives being
developed, promoted and implemented by WHO and its partners, and will therefore
contribute to the growing body of evidence-based HTM best practice.
The sponsors, authors and reviewers of this Series of Guides are to be congratulated
for what is a comprehensive and timely addition to the global HTM toolkit.
Andrei Issakov, Coordinator, Health Technology and Facilities Planning and

Management, World Health Organization, Geneva, Switzerland
Mladen Poluta, Director, UCT/WHO HTM Programme, University of Cape

Town, South Africa
ii
Acknowledgements
Acknowledgements
This Guide was written:
◆ with specialist support from:

Pieter de Ruijter, Consultant, HEART Consultancy, Holland
◆ with assistance from an Advisory Group of:

Hans Halbwachs, Healthcare Technology Management, Deutsche Gesellschaft für
Technische Zusammenarbeit (GTZ-GmbH), Eschborn, Germany
Peter Heimann, Director, WHO Collaborating Centre for Essential Health

Technologies, Medical Research Council of South Africa, Tygerberg, South Africa
Antonio Hernandez, Regional Advisor, Health Services Engineering and Maintenance,

PAHO/WHO, Washington DC, USA
Andrei Issakov, Coordinator, Health Technology and Facilities Planning and

Management, Department of Health System Policies and Operations, WHO,
Geneva, Switzerland
Yunkap Kwankam, Scientist, Department of Health Service Provision,WHO,

Geneva, Switzerland
Martin Raab, Biomedical Engineer, Swiss Centre for International Health of the
Swiss Tropical Institute, Basle, Switzerland
Gerald Verollet, Technical Officer, Medical Devices, Blood Safety and Clinical
Technology (BCT) Department, WHO, Geneva, Switzerland
Reinhold Werlein, Biomedical Engineer, Swiss Centre for International Health of the
Swiss Tropical Institute, Basle, Switzerland
◆ and reviewed by:

Dr P. Asman, Head of the Bio-engineering Unit, Ministry of Health, Ghana
Tsibu J. Bbuku, Medical Equipment Specialist, Central Board of Health,

Lusaka, Zambia
Juliette Cook, Biomedical Engineer, Advisor to Ministries of Health of Mozambique,

and Vanuatu
Peter Cook, Biomedical Engineer, ECHO International Health Services,

Coulsdon, UK
Trond Fagerli, Senior Advisor, Haraldsplass Deaconal Hospital, Bergen, Norway

(former Chief Bio-Medical Engineer, Ministry of Health, Botswana)
Freedom Dellosa, Chief of Hospital Equipment Maintenance Service Division,

Region 9 – Mindanao Peninsula, Department of Health, Zambonga City, Philippines
iii
Acknowledgements
Roland Fritz, HCTS Coordinator, Christian Social Services Commission, Dar es

Salaam, Tanzania
Andrew Gammie, Project Director, International Nepal Fellowship, Pokhara, Nepal
Muditha Jayatilaka, Deputy Director General of Health Services (Biomedical

Engineering Services), Ministry of Health, Nutrition and Welfare, Colombo, Sri Lanka
Dyness Kasungami, District Director of Health – Kafue DHMT/Reproductive

Health Advisor – USAID, Lusaka, Zambia
Godfrey Katabaro, Biomedical Engineering Technologist, Kagera Medical Technical

Services, church health sector, Kagera, Tanzania
Alex Manu, National Director of Finance, Aga Khan Foundation Private Hospital,
Nairobi, Kenya
Sulaiman Shahabuddin, Director, Patient Services, Aga Khan Foundation Private

Hospital, Nairobi, Kenya
Khout Thavary, Chief of Financial Planning Office, Ministry of Health,

Phnom Penh, Cambodia
Birgit Thiede, Physical Assets Management (PAM) Advisor, Ministry of Health,

Phnom Penh, Cambodia
Dr K. Upadhyaya, Medical Superintendent, Western Regional Hospital,

Pokhara, Nepal
◆ using source material:

as described in Annex 7: Source Material/Bibliography
◆ with financial assistance from:

the Knowledge and Research Programme on Disability and Healthcare Technology,
DFID, government of the United Kingdom
◆ with administrative support from:

all the staff at Ziken International Consultants Ltd, UK, especially Garth Singleton,
Rob Parsons, and Lou Korda, as well as Thomas Rebohle from FAKT, Germany
iv
Abbreviations
Abbreviations
ACA annual corrective activities

AEB annual equipment budget
AHA American Hospital Association
APA annual purchase activities
ARA annual rehabilitation activities
ATA annual training activities
BP blood pressure
CD-Rom compact disc – read only memory
CEEP core equipment expenditure plan
CEFP core equipment financing plan
CSSD central sterile supplies department
CT computed tomography (scanner)
DVD digital versatile disc
ECG electrocardiograph
EDP equipment development plan
ENT ear, nose and throat
ETP equipment training plan
FOB free-on-board
GTZ Deutsche Gesellschaft für Technische Zusammenarbeit
(German Government Technical Aid Agency)
HTM healthcare technology management
HTMS healthcare technology management service
HTMWG healthcare technology management working group
ICU intensive care unit
IEC International Electrotechnical Commission
INCO Terms international commercial terms (for transportation of trade)
ISO International Organization for Standardization
MOH Ministry of Health
MTBF mean-time between failures
NGO non-governmental organization
OPD out-patients department
p.a. per annum
v
Abbreviations
PPM planned preventive maintenance

UMDNS united medical devices nomenclature system
UPS uninterruptible power supply
US $ United States dollars
VEN/VED vital, essential, not so essential/desirable (prioritizing categories)
WHO World Health Organization
vi
List of boxes and figures
List of Boxes and Figures

Page
Box 1: Categories of items described as ‘healthcare technology’ 2
Box 2: Benefits of healthcare technology management (HTM) 4
Box 3: The planning and budgeting process described in this Guide 18
Box 4: Summary of issues in Section 2 on framework requirements 38
Box 5: Sample record sheet for taking the equipment inventory 44
Box 6: Other types of equipment information to keep 45
Box 7: Taking the equipment inventory 48
Box 8: Types of inventory code-numbering systems 51
Box 9: Example of equipment stock values for a 120-bed district
hospital (in 2003) 56
Box 10: Strategies for developing budget lines for
equipment expenditure 61
Box 11: Summary of procedures in Section 3 on discovering your
starting point 64
Box 12: Strategies for sourcing useful literature and expanding your library 67
Box 13: Equipment considerations for the vision at central level 71
Box 14: Equipment considerations for the vision at regional/district level 72
Box 15: Equipment considerations for the vision at facility level 73
Box 16: Exercise to develop your model equipment lists 78
Box 17: Example of valid reasons and order of priority for purchasing
and donations of equipment 81
Box 18: Example of good selection criteria for purchasing and
donations of equipment 82
Box 19: Example of valid reasons for condemning and replacing equipment 86
Box 20: Contents of a typical equipment specification 92
Box 21: Summary of procedures in Section 4 on discovering where
you are headed 97
Box 22: Principles behind replacement cost calculations 103
Box 23: How to make rough estimations of equipment purchase costs
for forward planning and bulk purchasing 108
Box 24: How to make exact estimates for specific equipment purchases 109
Box 25: Total purchase cost estimates depending on equipment type 109
Box 26: Suggestions for rough estimations of pre-installation costs for
forward planning 113
vii
Box 27: Suggestions for rough estimations of large-scale major

rehabilitation costs for forward planning 129
Box 28: Summary of procedures in Section 5 on capital budget calculations 131
Box 29: Elements of annual maintenance budgets 141
Box 30: Suggestions for rough estimations of consumable operating costs
for forward planning 148
Box 31: Examples of calculations for consumable operating costs 151
Box 32: Suggestions for rough estimations of equipment-related
administrative costs for forward planning 155
Box 33: Resources required when training staff 157
Box 34: Suggestions for rough estimations of equipment-related
ongoing training costs for forward planning 159
Box 35: Summary of procedures in Section 6 on recurrent
budget calculations 160
Box 36: Analysis required for the equipment development
planning process (in Figure 23) 166
Box 37: Example of the layout for an equipment development plan
record sheet 169
Box 38: Example of a summary Equipment Development Plan 170
Box 39: Ways of categorizing equipment for a bulk EDP 171
Box 40: Strategies for developing equipment skills 175
Box 41: Example of an Equipment Training Plan 179
Box 42: Example of a Core Equipment Development Plan 184
Box 43: Example of a Core Equipment Financing Plan 188
Box 44: Summary of procedures in Section 7 on making plans and budgets 189
Box 45: The VEN (or VED) system for prioritizing actions 201
Box 46: Sample Annual Action Plan for Equipment 205
Box 47: Sample Annual Equipment Budget 206
Box 48: Examples of how to measure goals 207
Box 49: Procedures for emergency equipment purchase requirements 212
Box 50: Procedures for maintenance contingencies 212
Box 51: Procedures for consumable contingencies 213
Box 52: Procedures for monitoring expenditure against allocations 214
Box 53: Monitoring the establishment of ‘tools’ 215
viii
Box 54: Summary of procedures in Section 8 on setting annual goals and

monitoring progress 217
Box 55: WHO’s definition of the technology management hierarchy
(Annex 1) 223
Box 56: Sample technical and environmental data sheet (Annex 5) 278
Box 57: Bare minimum planning and budgeting requirements (Annex 6) 279
Figure 1: The place of HTM in the health system 2

Figure 2: The relationship between the Guides in this Series 6
Figure 3: Healthcare technology performance related to your
management style 12
Figure 4: Cycle of planning and budgeting topics followed in this Guide 14
Figure 5: The structure of Guide 2 15
Figure 6: The healthcare technology management cycle 26
Figure 7: Sample organizational chart for the HTM Service 31
Figure 8: How to estimate total equipment stock values 55
Figure 9: The iceberg syndrome of life-cycle costs for healthcare technology 58
Figure 10: Exercise to establish your usage rates and requirements for
equipment-related consumable items 63
Figure 11: Steps for writing specifications 95
Figure 12: Steps for writing technical and environmental data sheets 97
Figure 13: The danger of a cyclical approach to funding equipment 101
Figure 14: How to make rough estimations of replacement costs for
Figure 15: How to make specific estimates of equipment pre-installation costs 115
Figure 16: How to make specific estimates of installation and
commissioning costs 121
Figure 17: How to make specific estimates of costs for initial training linked
to purchases 126
Figure 18: How to make specific estimates of large-scale major rehabilitation
project costs 130
Figure 19: Traditional ‘bath-tub’ curve of maintenance costs over the lifetime
of equipment 137
Figure 20: How to make rough estimations of maintenance costs for
Figure 21: How to make specific or annual estimates of maintenance costs 142
Figure 22: How to make specific or annual estimates of consumable
operating costs 151
ix
Figure 23: How to make specific estimates of assorted equipment-related

administrative costs annually 155
Figure 24: How to make specific estimates of annual equipment-related
ongoing training costs 159
Figure 25: The basic equipment development planning process 165
Figure 26: Example of prompts showing that training is required 174
Figure 27: Making an Equipment Training Plan 178
Figure 28: Making a Core Equipment Expenditure Plan 182
Figure 29: Making a Core Equipment Financing Plan 187
Figure 30: The planning and review cycle 191
Figure 31: Annual calendar for the planning and budgeting process 195
Figure 32: Updating the equipment inventory as part of the annual
planning process 196
Figure 33: Reviewing the EDP to determine your annual needs 197
Figure 34: Reviewing the ETP to determine your annual needs 198
Figure 35: Costing your annual needs 199
Figure 36: Reviewing the CEEP and CEFP, prioritizing the allocation of
funds, and preparing proposed annual plans and budgets 202
Figure 37: Updating all long-term plans and budgets with the final agreed
and financed annual actions 203
Figure 38: Shortened version of planning and budgeting (Annex 6) 280
x
1 Introduction
1. INTRODUCTION
Why is This Important?

This introduction explains the importance of healthcare technology
management (HTM) and its place in the health system.
It also describes:
◆ the purpose of the Series of Guides and this Guide in particular
◆ the people the Guides are aimed at

◆ the names and labels commonly used in HTM, in this Series.
The Series of Guides is introduced in Section 1.1, and this particular Guide on
planning and budgeting is introduced in Section 1.2.
1.1 INTRODUCTION TO THE SERIES OF GUIDES

Healthcare Technology Management’s Place in the Health System
All health service providers want to get the most out of their investments. To enable
them to do so, they need to actively manage health service assets, ensuring that they
are used efficiently and optimally. All management takes place in the context of your
health system’s policies and finances. If these are favourable, the management of
health service assets can be effective and efficient, and this will lead to improvements
in the quality and quantity of healthcare delivered, without an increase in costs.
The health service’s most valuable assets which must be managed are its human
resources, physical assets, and other resources such as supplies. Physical assets such
as facilities and healthcare technology are the greatest capital expenditure in any
health sector. Thus it makes financial sense to manage these valuable resources, and
to ensure that healthcare technology:
◆ is selected appropriately
◆ is used correctly and to maximum capacity

◆ lasts as long as possible.
Such effective and appropriate management of healthcare technology will contribute

to improved efficiency within the health sector. This will result in improved and
increased health outcomes, and a more sustainable health service. This is the goal of
healthcare technology management – the subject of this Series of Guides.
1
1.1 Introduction to this series of guides
Figure 1: The Place of Healthcare Technology Management in the Health System
Health
System
Po
Health Sector Organization

lic
and Management
ie
s
Human Resources Healthy

Facilities Population
Funds
Healthcare Technology Health
Consumable Supplies Service
Provision
What Do we Mean by Healthcare Technology?

The World Health Organization (WHO) uses the broader term ‘health technology’,
which it defines as including:
‘devices, drugs, medical and surgical procedures – and the knowledge associated
with these – used in the prevention, diagnosis and treatment of disease as well as
in rehabilitation, and the organizational and supportive systems within which care
is provided.’
(Source: Kwankam, Y, et al, 2001, ‘Health care technology policy framework’, WHO Regional Publications,
Eastern Mediterranean Series 24: Health care technology management, No. 1)
However, the phrase ‘healthcare technology’ used in this Series of Guides only refers
to the physical pieces of hardware in the WHO definition, that need to be
maintained. Drugs and pharmaceuticals are usually covered by separate policy
initiatives, frameworks, and colleagues in another department.
Therefore, we use the term healthcare technology to refer to the various equipment
and technologies found within health facilities, as shown in Box 1.
BOX 1: Categories of Equipment and Technologies Described as ‘Healthcare Technology’
medical equipment walking aids health facility furniture

communications equipment training equipment office equipment
office furniture fixtures built into the building plant for cooling, heating, etc.
service supply installations equipment-specific supplies fire-fighting equipment
workshop equipment fabric of the building vehicles
laundry and kitchen equipment waste treatment plant energy sources
For examples of these different categories, see the Glossary in Annex 1.
2
Often, different types of equipment and technologies are the responsibility of

different organizations. For example, in the government sector, different ministries
may be involved, such as Health, Works, and Supplies; and in the non-government
sector, different agencies may be involved, such as Health, and Logistics.
The range of healthcare technology which falls under the responsibility of the health
service provider varies from country to country and organization to organization.
Therefore each country’s definition of healthcare technology will vary depending on
the range of equipment and technology types that they actually manage.
For simplicity, we often use the term ‘equipment’ in place of the longer
phrase ‘healthcare technology’ throughout this Series of Guides.
What is Healthcare Technology Management?

First of all, healthcare technology management (HTM) involves the organization and
coordination of all of the following activities, which ensure the successful
management of physical pieces of hardware:
◆ Gathering reliable information about your equipment.
◆ Planning your technology needs and allocating sufficient funds for them.
◆ Purchasing suitable models and installing them effectively.
◆ Providing sufficient resources for their use.
◆ Operating them effectively and safely.
◆ Maintaining and repairing the equipment.
◆ Decommissioning, disposing, and replacing unsafe and obsolete items.
◆ Ensuring staff have the right skills to get the best use out of your equipment.
This will require you to have broad skills in the management of a number of
areas, including:
◆ technical problems
◆ finances
◆ purchasing procedures
◆ stores supply and control
◆ workshops
◆ staff development.
3
However, you also need skills to manage the place of healthcare technology in the
health system. Therefore, HTM means managing how healthcare technology should
interact and balance with your:
◆ medical and surgical procedures
◆ support services
◆ consumable supplies, and
◆ facilities
so that the complex whole enables you to provide the health services required.
Thus HTM is a field that requires the involvement of staff from many disciplines
– technical, clinical, financial, administrative, etc. It is not just the job of managers, it
is the responsibility of all members of staff who deal with healthcare technology.
This Series of Guides provides advice on a wide range of management procedures,

which you can use as tools to help you in your daily work. For further clarification of
the range of activities involved in HTM and common terms used, refer to the
WHO’s definition of the technology management hierarchy in Annex 1.
Box 2 highlights some of the benefits of HTM.
BOX 2: Benefits of Healthcare Technology Management (HTM)
◆ Health facilities can deliver a full service, unimpeded by non-functioning healthcare technology.
◆ Equipment is properly utilized, maintained, and safeguarded.
◆ Staff make maximum use of equipment, by following written procedures and good practice.
◆ Health service providers are given comprehensive, timely, and reliable information on:
- the functional status of the equipment
- the performance of the maintenance services
- the operational skills and practice of equipment-user departments
- the skills and practice of staff responsible for various equipment-related activities in a range of
departments including finance, purchasing, stores, and human resources.
◆ Staff control the huge financial investment in equipment, and this can lead to a more effective and
efficient healthcare service.
4
Purpose of the Series of Guides

The titles in this Series are designed to contribute to improved healthcare
technology management in the health sectors of developing countries, although they
may also be relevant to emerging economies, and other types of country. The Series
is designed for any health sector, whether it is run by:
◆ government (such as the Ministry of Health or Defence)
◆ a non-governmental organization (NGO) (such as a charitable or

not-for-profit agency)
◆ a faith organization (such as a mission)
◆ a corporation (for example, an employer such as a mine, who may subsidize
the healthcare)
◆ a private company (such as a health insurance company or for-profit agency).
This Series aims to improve healthcare technology at a daily operational level, as well
as to provide practical resource materials for equipment users, maintainers, health
service managers, and external support agencies.
To manage your technology effectively, you will need suitable and effective procedures
in place for all activities which impact on the technology. Your health service provider
organization should already have developed a Policy Document setting out the
principles for managing your stock of healthcare technology (Annex 2 provides a
number of resources available to help with this). The next step is to develop written
organizational procedures, in line with the strategies laid out in the policy, which staff
will follow on a daily basis.
The titles in this Series provide a straightforward and practical approach to healthcare
technology management procedures:
Guide 1 covers the framework in which Healthcare Technology Management

(HTM) can take place. It also provides information on how to organize a network of
HTM Teams throughout your health service provider organization.
Guides 2 to 5 are resource materials which will help health staff with the daily
management of healthcare technology. They cover the chain of activities involved in
managing healthcare technology – from planning and budgeting to procurement,
daily operation and safety, and maintenance management.
Guide 6 looks at how to ensure your HTM Teams carry out their work in an
economical way, by giving advice on financial management.
How the Guides are coordinated is set out in Figure 2.
5
Figure 2: The Relationship Between the Guides in This Series
Framework/structure
Organizing a network of
HTM Teams (Guide 1)
Pro
d c
g a n c om urem
i n g m e
nn tin (G issio nt an
Pla udge e 2) uid ni d
b uid e 3 ng
(G )
Chain of activities
in the equipment
Ma life cycle ion
ma inten e rat y
n a p
o fet
(G agem nce aily d sa e 4)
uid D an uid
e 5 ent
) (G
Ensuring efficiency
Financial management of HTM Teams (Guide 6)
Who are These Guides Aimed at?

These Guides are aimed at people who work for, or assist, health service provider
organizations in developing countries. Though targeted primarily at those working in
health facilities or within the decentralized health authorities, many of the principles
will also apply to staff in other organizations (for example, those managing health
equipment in the Ministry of Works, private maintenance workshops, and head offices).
Depending on the country and organization, some daily tasks will be undertaken by
end users while others may be carried out by higher level personnel, such as central
level managers. For this reason, the Guides cover a range of tasks for different types of
staff, including:
◆ equipment users (all types)
◆ maintenance staff
◆ managers
◆ administrative and support staff
◆ policy-makers
◆ external support agency personnel.
6
They also describe activities at different operational levels, including:

◆ the health facility level
◆ the zonal administration level (such as district, regional, diocesan)

◆ the central/national level
◆ by external support agencies.
Many activities require a multi-disciplinary approach, therefore it is important to form

mixed teams which include representatives from the planning, financial, clinical,
technical, and logistical areas. Allocation of responsibilities will depend upon a
number of factors, including:
◆ your health service provider
◆ the size of the organization

◆ the number of decentralized levels of authority
◆ the size of your health facility
◆ your level of autonomy.
The names and titles given to the people and teams involved will vary depending on
the type of health service provider you work with.
For the sake of simplicity, we have used a variety of labels to describe

different types of staff and teams involved in HTM.
This Series describes how to introduce healthcare technology management into your
organization. The term Healthcare Technology Management Service (HTMS) is
used to describe the delivery structure required to manage equipment within the
health system. This encompasses all levels of the health service, from the central
level, through the regions/districts, to facility level.
There should be a referral network of workshops where maintenance staff with

technical skills are based. However, equipment management should also take place
where there are no workshops, by involving general health facility staff. We call these
groups of people the HTM Team, and we suggest that you have a team at every level
whether a workshop exists or not. Throughout this Series, we have called the person
who leads that team the HTM Manager.
At every level, there should also be a committee which regularly considers all
equipment-related matters, and ensures decisions are made that are appropriate to
the health system as a whole. We have used the term HTM Working Group
(HTMWG) for this committee, which will advise the Health Management Teams on
all equipment issues.
7
Due to its role, the HTMWG must be multi-disciplinary. Depending on the

operational level of the HTMWG, its members could include the following:
◆ Head of medical/clinical services.
◆ Head of support services.
◆ Purchasing and supplies officer.
◆ Finance officer.
◆ Representatives from both medical equipment and plant maintenance.
◆ Representatives of equipment users from a variety of areas (medical/clinical,
nursing, paramedical, support services, etc.).
◆ Co-opted members (if specific equipment areas are discussed or specific interest
or need is shown).
The HTM Working Group prepares the annual plans for equipment purchases,
rehabilitation, and funding, and prioritizes expenditure across the facility/district as a
whole. It may have various sub-groups to help consider specific aspects of equipment
management, such as pricing, commissioning, safety, etc.
How to Use These Guides

Each Guide has been designed to stand alone, and has been aimed at different types
of readers depending on its content (Section 1.2). However, since some elements
are shared between them, you may need to refer to the other Guides from time to
time. Also, if you own the full Series (a set of six Guides) you will find that some
sections of the text are repeated.
We appreciate that different countries use different terms. For example, a purchasing
officer in one country may be a supplies manager in another; some countries use
working groups, while others call them standing committees; and essential service
packages may be called basic healthcare packages elsewhere. For the purpose of
these Guides it has been necessary to pick one set of terms and define them. You can
then modify them for your own situation.
The terms used throughout the text are outlined, with examples, in the
Glossary in Annex 1.
We appreciate that you may find it hard to pursue the ideas introduced in these
Guides. Depending on your socio-economic circumstances, you may face many
frustrations on the road to achieving effective healthcare technology management.
We recognize that not all of the suggested procedures can be undertaken in all
environments. Therefore we recommend that you take a step-by-step approach,
rather than trying to achieve everything at once (Section 2).
8
1.2 Introduction to this specific guide
These Guides have been developed to offer advice and recommendations only,
therefore you may wish to adapt them to meet the needs of your particular situation.
For example, you can choose to focus on those management procedures which best
suit your position, the size of your organization, and your level of autonomy.
For more information about reference materials and contacts for healthcare
technology management, see Annex 2.
1.2 INTRODUCTION TO THIS SPECIFIC GUIDE

Why Is There a Need for Equipment Planning and Budgeting?
Healthcare technology is such an important part of healthcare today that it cannot

easily be ignored. It has a very wide application; for example equipment is used to:
◆ help diagnose whether a patient has malaria
◆ treat a patient by removing their gall stones
◆ monitor the condition of a patient’s heart
◆ provide therapy in order to get a patient moving about again
◆ control the environment by supplying heat and light
◆ provide necessities such as running water
◆ transport patients and staff
◆ feed patients and staff
◆ provide clean surroundings.
The expansion in healthcare technologies has brought with it many new challenges.
For example:
◆ Health service providers and the general public believe that this technology offers
great promise for improving conditions for the sick.
◆ The public expects their health services to be continually improving.
◆ Manufacturers, professional staff, and the private health sector exert pressure to
introduce the latest technological advances.
◆ People commonly believe that quality of care is directly linked to the presence of
sophisticated technologies.
9
Did you know?

◆ 80 per cent of the world’s population is not able to afford US$100 per head per year on health.
◆ Many sub-Saharan African countries cannot even spend US$15 per head per year on health.
◆ The majority of equipment is designed in countries that spend between US$1,500 and 2,500
per head per year on health.
◆ For 80 per cent of the world’s population, the standards and technology set by the equipment-
manufacturing nations are not sustainable.
Planning and Budgeting Equipment – Why Does It Matter?

1. Planning and budgeting helps you to control the direction of
technology development in your country.
Investing in expensive technologies can lead to many potential difficulties. For example:
◆ The capabilities of the technology may increase at a faster rate than the country’s
infrastructure and support systems can cope with.
◆ Large amounts of money may be spent on expensive and complex new
technologies which do not always lead to the improvements hoped for, in terms of
better access to healthcare and a better quality service.
◆ When investing in technology, planners may fail to take account of the potential
impact on other spending needs (for example, maintenance costs, extra staff
requirements, operational costs, replacement funding).
◆ Planners may fail to take into account the recurrent cost burden of such technologies.
This could have a negative impact on long-term health service budgets, creating a
serious imbalance in health service provision and existing services.
In order to maintain a quality health service, careful planning of your existing and
future healthcare technology needs is essential. Before investing in expensive and
complex technologies, ask yourself whether there are other, more effective means by
which you could improve the quality and level of health services which you deliver to
the public.
Did you know?

◆ In many poor countries, 50 per cent of health finances goes to the highest referral level, while
all the other services have to share the remaining 50 per cent.
◆ Thus, the equity statement that many countries have in their health plan/policy is not really served.
◆ It is possible to consider the cost-effectiveness of using different types of equipment.
◆ Although controversial, it could be argued that providing basic facilities for sterilizing
instruments is of a higher level of priority than an X-ray service, for example.
10
2. Planning your equipment requirements helps to obtain the right

balance within your budget between various needs.
It is common in many developing countries to find:
◆ considerable cuts are made in recurrent expenditures
◆ funds for salaries are often protected

◆ money for other costs is frequently limited. For example, fuel is often not available
or reagents are insufficient for existing services
◆ there is no guarantee that the recurrent costs required for new services will be
provided sufficiently to run the equipment properly.
Did you know?

◆ European Community countries spend more than US$53 per person on medical equipment
per year, Japan more then $92, and the United States more than $118.
◆ But sub-saharan African countries spend on average less than $1 per person on medical
equipment per year, and the less developed countries in Asia spend only around $12
◆ In most countries, capital expenditure on buildings and equipment is typically not more than
five per cent of the total annual healthcare expenditure.
◆ In some developing countries, however, this can rise to as much as 40 per cent over short
periods (1–2 years), due to the injection of donor funds for the occasional construction or
rehabilitation project.
◆ In many developing countries, 66 per cent or more of the recurrent health budget is spent on
staff salaries.
◆ This leaves only a small fraction of the total budget for all the remaining requirements –
maintenance of buildings and equipment, skill development, and consumables.
◆ As a result, many staff do not have the tools required to do their jobs.
Health service providers may concentrate on obtaining the right staff for the delivery
of healthcare. But there is little use in allocating a large proportion of the health
budget on salaries, if the staff do not have the necessary tools to work with. Without
functioning facilities, equipment, and medicines, it does not matter if the knowledge,
skills and staff levels are high. The delivery of services will be poor.
Poor investment in technology will also have a negative impact on staff motivation,
leading to poor performance. Therefore, when planning and allocating your budgets,
it is important to maintain the right balance between staffing and technology costs.
11
3. Planning is essential, in order to make the most of your assets.

Developing countries have limited funds, so it is important to ensure that any
investment in healthcare technology has been properly thought through.
Good management practices will

create sustainable circumstances for Did you know?
your healthcare technology. To achieve ◆ In one South American country, it is
this, you will need to plan and budget estimated that the replacement value of
for the regular replacement of medical equipment is US$5 billion.
equipment, effective maintenance, ◆ But 40 per cent of this equipment is
and training needs. Figure 3 illustrates not functioning.
how effective management can ◆ This represents a loss of assets of
improve the performance of your US$2 billion.
healthcare technology.
Figure 3: Healthcare Technology Performance Related to Your Management Style
Sustainable C
B
Equipment availability
(% of total)
Not sustainable
Time
Curve A: Crisis Management:

◆ major periodic injections of new equipment
◆ poor preservation of existing stock
Curve B: Stable Healthcare Technology Management:

◆ preservation (maintenance) of equipment
◆ regular planned replacement
Curve C: Good Healthcare Technology Management:

◆ preservation of equipment
◆ regular planned replacement
◆ improved performance through internal learning processes
Source: Remmelzwaal, B, 1994, ‘Foreign aid and indigenous learning’, Science Policy Research Unit,
University of Sussex, UK
12
Who is this Guide Aimed at?

This Guide is particularly suitable for the following:
◆ Managers, and planning and finance officers within your organization
◆ Technical (maintenance) and administrative staff in your Healthcare Technology
Management Service
◆ Other types of staff who have various responsibilities relating to planning and
budgeting, such as:
- administrators, heads of department
- purchasing, human resources, supplies and stores personnel
◆ Policy makers.
All these staff should have a good understanding of equipment planning and
budgeting issues, in their common effort to provide an effective and sustainable
health service.
The recommendations and procedures outlined in this Guide are aimed at personnel
at various levels of your organization (facility, district/region, central). The Guide
explains what the responsibilities are at all levels of the system, to enable you to see
the bigger picture.
Tip • The principles of planning and budgeting are the same wherever the money comes
from – whether received from patients, government funds, private support or any
other source.
What Topics are Covered?

Managing the planning and budgeting of equipment involves understanding and
developing a series of ‘tools’. These tools enable you to make your equipment plans
and calculate your budgets, which will ensure that you have sufficient stocks of
functioning equipment to be able to deliver your health services.
This Guide answers the following questions for your healthcare technology sector:
◆ What is my current equipment situation – where am I starting from?
◆ What are my future plans for my equipment?
◆ How do I make budget calculations for capital expenditure?
◆ How do I make budget calculations for recurrent expenditure?
◆ How do I develop the plans and budgets for my equipment in the long-term and
short-term?
◆ How do I review my plans and budgets annually, and monitor progress?
13
Figure 4 shows how the topics covered in this Guide fit together to create a
planning and budgeting cycle. In Section 8, we go on to discuss the way in which
this planning and budgeting cycle relates to your annual calendar.
Figure 4: Cycle of Planning and Budgeting Topics Followed in This Guide
a. Developing b. Understanding
planning tools budget calculations
Cycle of
Topics
e. Monitoring c. Making
progress long-term plans
d. Making
annual plans
Tip • Putting into place the procedures outlined in this Guide may appear to be a
daunting task, on first sight. However, by taking a step-by-step approach, you can
minimize the effort involved. The discussion of tools (Sections 3–6) covers one-off
exercises which you can undertake to set up the tools initially. Section 7 goes on to
explain how to set up the long-term plans and budgets. Finally, Section 8 goes on to
explain how to regularly review and update the existing tools, plans, and budgets
during the annual planning process.
• If this Guide is still too daunting, Annex 6 offers advice on a shortened version of
planning and budgeting for those just starting out.
The system introduced in this Guide provides a solid approach to managing

equipment planning and budgeting. However, we recognize that there are other
ways of organizing these issues which may be more appropriate for your
administrative system. The most important thing is to implement a well-
functioning system.
As you read through the recommendations in this Guide, you may find it useful to
refer to advice in other Guides in the Series, as indicated in the text. Additional
useful reference materials and contacts are given in Annex 2.
14
How is This Guide Structured?

The structure of Guide 2 highlights the different steps you must take in order to
plan and budget for your healthcare technology, as shown in Figure 5.
Figure 5: The Structure of Guide 2
Section 1 Introducing the Series, and this particular Guide
Understanding the central framework for HTM, and

Section 2
background conditions specific to this Guide
Developing planning tools that tell you your starting

Section 3
point for making plans
Developing planning tools that tell you the direction

Section 4
in which you are headed
Understanding budgeting tools for capital budget

Section 5
calculations
Understanding budgeting tools for recurrent budget

Section 6
calculations
Using these tools to make long-term equipment

Section 7
plans and budgets
Reviewing and updating the plans and budgets

Section 8
annually, and monitoring progress and expenditure
Who Does What in Planning and Budgeting?

Depending on how many staff you have with management skills, planning and
budgeting tasks may take place at any level. This will depend on:
◆ your country

◆ which level of the health service you work at
◆ the degree of autonomy of your health facility.
15
However if you have limited management skills at your level, and planning and
budgeting presents a heavy workload, much of this work should be undertaken at a
higher level in your organization.
We suggest that the HTM Working Group (Section 1.1) has a large role to play in
advising the Health Management Team on all equipment matters. Depending on
the size of your facility or what level of the health service you are operating at, your
HTM Working Group may prefer to set up a number of smaller sub-groups.
The suggestions given in this Guide are only intended as examples of the type of
background required for the members of the sub-groups. It is likely that many staff
will sit on more than one sub-group. If you are short of staff, you could use fewer
members, as relevant to the operational level of the sub-group.
In this Guide, the following groups and sub-groups are suggested:
A planning sub-group, which is responsible for equipment development planning

could have the following types of members:
◆ Head of the Health Facility or Head of Medical Services (as team leader)
◆ HTM Manager
◆ Finance Officer
◆ maintenance staff from various disciplines
◆ Nursing Services Manager
◆ Support Services Manager
◆ co-opted members (it is important to involve relevant users as each department
is considered).
A stock sub-group, which evaluates the usage rates and recurrent stock
requirements for equipment-related consumable items could have the following
types of members:
◆ Purchasing and Supplies Officer
◆ HTM Manager
◆ Stores Controller
◆ representatives from equipment user departments (as appropriate to the
equipment being considered).
16
A training sub-group, which considers equipment-related training issues, could

include the following types of staff:
◆ Human Resource Manager
◆ Head of Medical Services

◆ Head of Support Services
◆ HTM Manager
◆ In-service Training Coordinator
◆ Infection Control Officer, senior users, and maintenance staff (as appropriate to
the equipment being considered).
A pricing sub-group, which is responsible for developing equipment price lists and
stock values, and which could include the following types of staff:
◆ HTM Manager
◆ Medical Equipment Maintenance Technician.
A Specification Writing Group which is responsible for developing a library of

generic equipment specifications, and the technical and environmental data sheet.
This could include the following types of staff:
◆ HTM Manager

◆ managers and representatives from equipment user departments
– clinical, paramedical, and support services (as appropriate to the equipment
being considered).
A Commissioning Team, which is responsible for overseeing or undertaking the

installation and commissioning of new equipment. This could include the following
types of staff:
◆ HTM Manager

◆ Support Services Manager
◆ representatives from equipment user departments (as appropriate to the
equipment being considered)
◆ where necessary, stores and grounds staff to help move and open crates.
17
Section 1 summary
A Tender Committee, which will decide which quotes to accept for the equipment
and services you plan and budget for. A full description of this team is described in
Guide 3.
Tip • There may seem to be a large number of sub-groups but the aim is to spread the work
around different members of staff so that the HTM Working Group (Section 1.1)
does not have to do everything.
• If you have a small health facility with few staff, the groups created to undertake
planning and budgeting could be much smaller. Try to use relevant staff with
experience and involve those who show an interest in the task.
A wide range of people will be involved in planning and budgeting, as can be seen
from the membership of these sub-groups. It is important for everybody involved to
understand the planning and budgeting process that will be followed in this Guide.
This process is described in Box 3.
BOX 3: The Planning and Budgeting Process Described in this Guide
Steps in the Process People Responsible Actions Described in this Guide
Framework Requirements (Section 2)

Plan and budget within Health service managers ◆ follow regulations and standards set by government
the framework of at central level in ◆ develop a Healthcare Technology Policy including
guidance and direction consultation with decisions on standardization, maintenance
from the central level of managers at other levels provision, finances for HTM activities, and the
your health service organizational structure for an HTM Service
provider
◆ define the overall ‘Vision’ for healthcare delivery
at each level of the health service
◆ develop ‘Model Equipment Lists’ which define
the essential equipment stock for the healthcare
to be delivered at each level
◆ use ‘Generic Equipment Specifications’ for
acquisition of equipment
◆ develop good policies for purchasing, donations,
replacement, and disposal of equipment.
Continued opposite
18
Section 1 summary
BOX 3: The Planning and Budgeting Process Described in this Guide (continued)
Knowing where you are starting from (Section 3)

Increase the availability HTM Managers ◆ establish an Equipment Inventory to keep up-to-
of planning skills for date records of the current equipment stock.
equipment at all service
HTM Working Groups ◆ estimate the equipment stock values
levels, by developing
and sub-groups define the usage rates of equipment-related
planning ‘tools’ through ◆
one-off exercises consumable items so that realistic estimates can

be made of the finances required for equipment
accessories, consumables, and spare parts.
Finance Officers ◆ set up budget lines to record and monitor

expenditure on all the different equipment
activities.
Knowing where you are headed (Section 4)

Health Management ◆ develop a library of literature and sources of
Teams advice which will help with equipment planning
and budgeting
◆ adapt the Vision for healthcare delivery at their
service level
◆ adopt good policies for purchasing, donations,
replacement, and disposal of equipment.
HTM Working Groups ◆ adapt the Model Equipment List for their
service level.
HTM Working Groups ◆ develop Generic Equipment Specifications and

and sub-groups technical and environmental data.
Capital budget calculations (Section 5)

Ensure realistic HTM Working Groups ◆ calculate expenditure requirements for
estimates are made for and sub-groups replacement items
all equipment-related ◆ calculate expenditure requirements for new
allocations at all service purchases
levels, by using
◆ calculate expenditure requirements for support
budgeting ‘tools’ which
activities linked to purchases and donations.
teach you how to
calculate the HTM Managers and ◆ calculate expenditure requirements for pre-
expenditures required their Teams installation work
◆ calculate expenditure requirements for major
rehabilitation work.
Continued overleaf
19
Section 1 summary
Recurrent budget calculations (Section 6)

Ensure realistic HTM Managers and ◆ calculate recurrent expenditure requirements for
estimates are made for their Teams maintenance.
all equipment-related
Heads of Section ◆ calculate recurrent expenditure requirements for
allocations at all service
consumable operating costs.
levels, by using
budgeting ‘tools’ which HTM Working Groups ◆ calculate recurrent expenditure requirements for
teach you how to and sub-groups administrative expenses
calculate the
◆ calculate recurrent expenditure requirements for
expenditures required
ongoing training.
Long-term planning (Section 7)

Use the tools to make HTM Working Groups ◆ establish an Equipment Development Plan
long-term plans and and sub-groups covering the priorities for equipment needs across
budgets their service level over time
◆ establish an Equipment Training Plan to cover
the ongoing rolling programme of training required
in relation to equipment activities
◆ establish a Core Equipment Expenditure Plan
which prioritizes equipment spending across the
facility over the long-term
◆ establish a Core Equipment Financing Plan which
identifies sources of funds for the long-term plans.
Annual planning (Section 8)

Review the plans and HTM Teams ◆ update the Equipment Inventory.
budgets annually, and
HTM Working Groups ◆ update the Equipment Development Plan
monitor progress in
and sub-groups update the Equipment Training Plan
order to improve ◆
planning and budgeting ◆ cost the capital and recurrent requirements for
the current year, and update the Core Equipment
Expenditure Plan and Core Equipment
Financing Plan
◆ prioritize across their service level to obtain the
Annual Purchase Activities, Annual Rehabilitation
Activities, Annual Corrective Activities, Annual
Training Activities, and therefore obtain their
Annual Equipment Budget.
Continued opposite
20
Section 1 summary
Monitoring progress (Section 8)

Review the plans and HTM Working Groups ◆ ensure annual plans are implemented
budgets annually, and ◆ study the implications arising from planning and
monitor progress in budgeting.
order to improve
planning and budgeting Heads of Department ◆ request help for any deviations from plans such as
and HTM Managers emergency purchases, maintenance and
consumable contingencies
◆ monitor actual expenditure against allocations.
Health Management ◆ seek the funding identified

Teams ◆ consider linking allocation of budgets to whether
departments achieve their performance targets
◆ monitor progress with establishing all planning
and budgeting ‘tools’
◆ ensure that the information generated by the
‘tools’ is used to improve stock control, training,
procurement, etc.
Tip • Remember – if you do not think you can undertake all this work initially, Annex 6
contains a shortened version of planning and budgeting for equipment based on parts
of this Guide.
21
22
2 Framework requirements
2. FRAMEWORK REQUIREMENTS

In order to deliver quality health services, it is essential to undertake effective
healthcare technology management.
There are various framework requirements to help you do this. These include
legislation, regulations, standards, and policies.
These framework requirements create the boundary conditions within which
you undertake healthcare technology management. They include central or
national guiding principles, policy issues, and high-level assumptions that can
impede or assist you in your work.
It is very difficult to function effectively if these framework requirements do not
exist, and you should lobby your organization to develop them.
Depending on how autonomous your health facilities are, you may be able to
develop these framework requirements at facility, region/district, or central level.
In most industrialized countries, laws, regulations, policies and guidelines form an

indispensable part of health service management. For many developing countries,
however, these regulatory procedures have yet to be developed.
Guide 1 provides a fuller analysis of how to develop these instruments, and shows that
effective healthcare technology management (HTM) is essential in order to deliver
quality health services. Section 2.1 summarizes these points and offers advice on:
◆ the regulatory role of government
◆ establishing standards for your health system

◆ policy issues for HTM
◆ the importance of introducing an HTM Service
◆ managing change.
Section 2.2 goes on to discuss the background conditions specific to this Guide, and
provides advice on:
◆ authorities responsible for guidance on equipment planning and budgeting
◆ central plans and policies, management skill requirements, and economies of scale
for planning and budgeting.
23
2.1 Framework requirements for quality health services
2.1 FRAMEWORK REQUIREMENTS FOR QUALITY

HEALTH SERVICES
Regulatory Role of Government
The World Health Organization (WHO) identifies four distinct functions for
health systems:
◆ The provision of health services.
◆ The financing of health services.
◆ The creation of health resources (investment in facilities, equipment, and training).
◆ The stewardship of health services (regulation and enforcement).
Health service provision and financing, as well as resource creation may be taken on by
both the government and private sector. Thus, there are various options for organizing
health systems:
◆ Mainly public.
◆ Mainly private for-profit (for example, run by a commercial organization), and
private not-for-profit (for example, run by faith organizations, NGOs).
◆ A mixture of government and private organizations.
However in all these systems, the government is solely responsible for the regulation
of health services. The reason for this is that the government has a duty to ensure
the quality of healthcare delivered in order to protect the safety of the population.
These regulations may then be enforced directly by government bodies or they may
be enforced by publicly funded bodies, such as professional associations, which apply
government sanctioned regulations.
Most governments would agree that the protection of health and the guarantee of
safety of health services is vital. However, in many countries this regulatory function is
underdeveloped, with weak legal and regulatory frameworks.
To regulate health services, the government should:

◆ adopt suitable quality standards for all aspects of health services, including
acceptable international or national standards for healthcare technology, drugs,
and supplies in order to ensure their efficacy, quality and safety
◆ establish systems to ensure standards are met, so that the bodies enforcing
regulations have legal sanctions they can use if standards are infringed
◆ establish wide-ranging policies covering all aspects of the utilization,
effectiveness, and safety of healthcare technology, drugs, and supplies
◆ establish systems to ensure these policies can be implemented.
24
For health services, the Ministry of Health is the body most likely to develop these
government regulations. Other health service providers need to be guided by
government laws, and should look to the Ministry of Health for guidance or follow
their direction if required to do so by law or regulation.
Establishing Standards for your Health System

The government should agree on which quality standards have to be met by the
health services in general. These will cover areas such as:
◆ procedures and training
Standard ◆ construction of facilities
a required or agreed level
of quality or attainment ◆ healthcare technology, drugs, and supplies
set by a recognized authority, ◆ safety
used as a measure,
◆ the environment
norm, or model.
◆ quality management.
Since drawing up these standards can be both time consuming and expensive,
governments may often choose to adopt acceptable international standards (such as
ISO), rather than develop their own. However, they must be suitable and applicable
to your country situation and fit in with your country’s vision for health services.
The adoption of suitable international or national standards for healthcare technology

is of particular relevance to this Guide. Such standards would cover areas such as:
◆ manufacturing practices
◆ performance and safety

◆ operation and maintenance procedures
◆ environmental issues (such as disposal).
These are important since countries can suffer if they acquire sub-standard and
unsafe equipment. Again, in the majority of cases ministries of health would save
money and time by adopting internationally recognized standards. For more
information on introducing internationally recognized standards into your
procurement procedures, refer to Guide 3 on procurement and commissioning.
It is not enough simply to establish these standards; they also need to be adhered to. For
this reason, you should establish a national supervisory body that has the power to ensure
that health service providers comply with the standards in force. To be effective, such
an enforcement agency must be allocated sufficient financial and personnel resources.
It should also be linked or networked with corresponding international bodies.
Much healthcare technology in developing countries is received through foreign aid

and donations, but such products don’t always meet international standards.
Therefore, your country will need to negotiate with external support agencies. The
best way to do this is to develop regulations for donors that supply equipment (see
Annex 2, and Guide 3 on procurement and commissioning).
25
The legal system plays an important role in enforcing such standards, by ensuring
that any infringements can be effectively prosecuted. It is therefore essential that
the legal system is allocated sufficient financial and human resources to enforce
claims against any institution operating equipment that does not meet the
prescribed standards.
Developing Policies for Health Services

Every country needs to establish wide-ranging policies covering all aspects of health
services. National health policies are usually developed by the Ministry of Health. If
these policies are linked to regulations, then other health service providers must also
follow them. Each health service provider can expand them internally, and must
establish systems to ensure they are implemented.
One key framework requirement for this Series of Guides is that your health service
provider should have started work on a Healthcare Technology Policy (for guidance
on this process, see Annex 2). Such a policy usually addresses all the healthcare
technology management (HTM) activities involved in the life-cycle of equipment,
as shown in Figure 6.
Figure 6: The Healthcare Technology Management Cycle
Planning and
Assessment
Decommissioning Budgeting and
and Disposal Financing
Maintenance Technology Assessment

and Repair and Selection
• Create
awareness
• Monitor
and
evaluate
Operation Procurement
and Safety and Logistics
Training and Skill Installation and

Development Commissioning
26
Here we will consider just four issues that provide key background conditions:
◆ A Vision for health services.
◆ Standardization.
◆ The provision of maintenance.
◆ Finances.
A Vision for Health Services

Every health service provider needs a realistic Vision of the service it can offer. This
should include a clear understanding of its role in relation to other health service
providers in the national health service. Only when this Vision is known can the
health service provider decide what healthcare technology is needed, and prioritize
the actions required to develop its stock of equipment.
It is unhelpful if lots of individual health facilities pull in different directions, with

no coordinated plan for the health service as a whole. The central authority of each
health service provider should be responsible for considering what sort of healthcare
should be offered at each level of their health service. Preferably they will collaborate
with the Ministry of Health, or follow their guidance if regulated to do so.
If there is no health service plan, there is no framework on which to base decisions.

Section 4.2 provides further information on developing a Vision and planning your
healthcare technology stock.
Standardization of Healthcare Technology

Introducing an element of standardization for healthcare
Standardization technology will help you to limit the wide variety of makes and
(also known as rationalization,
models of equipment found in your stock. By concentrating on a
normalization and harmonization)
smaller range for each equipment type, your technical,
– the process of reducing the
range of makes and models of procedural, and training skills will increase and your costs and
equipment available in your stock, logistical requirements will decrease (see Guide 1).
by purchasing particular named
It is easier to achieve standardization if equipment is planned and
makes and models.
ordered on a country-wide, district-wide or health service
provider basis. It is therefore important to combine forces with
other facilities or health service providers, and it may be wise to follow standardization
strategies of the Ministry of Health. It is important that these standardization efforts
do not just apply to products purchased by health facilities, but also to donations.
Standardizing your healthcare technology may be difficult for a number of reasons.

Your country and local businesses may have their own trade practices and interests.
National donors may have tied-aid practices, while the procurement procedures of
international funding agencies, health service institutions, and individuals may act
against your standardization strategies (see Guide 3).
27
You may need to hold discussions with organizations such as the Ministry of Industry
and/or Trade, the chambers of commerce or specific business associations, as well as
external support agencies. However, it is well worth persevering, as standardization
offers many benefits, both in terms of cost and efficiency.
Provision of Maintenance
Proper maintenance is essential to ensure that the equipment you have purchased
continues to meet the standards required throughout its entire working life.
Undertaking maintenance belongs to the service provision function of health

systems, and could therefore, in principle, be carried out by the government, the
private sector, or by a mixture of the two.
It is useful to organize the maintenance system along similar lines to the health
service provision already existing in your country. For instance, if the health sector is
predominantly run by the government, it is probably simplest to let the government
run the maintenance organization as well. In contrast, if private organizations run the
health services, it makes little sense for the maintenance activities to be carried out
by a government body. In the majority of cases, a mixed system is most likely.
However, the government may wish to take a regulatory role and establish
regulations that guarantee that healthcare technology performs effectively,
accurately, and safely. The rules established are valid for all health service providers,
irrespective of their type of organization.
Specific maintenance requirements would not need to be prescribed by the regulatory

body. Instead, it is up to individual health service providers to decide how these will
be provided. However, the nature and the complexity of some maintenance services
often calls for partnerships between the public and private health service providers.
Partnerships may also exist between health service providers and private sector
sources of maintenance support. For more details, refer to Guide 1.
To provide maintenance services, you will normally need to establish good links
between maintenance workshops. This will create a network that supports the needs
of all your health facilities. Maintenance is, of course, only one of many HTM
activities that need to be carried out. However, the fact that maintenance workshops
usually already exist in most countries serves as a useful starting point for establishing
a physical HTM Service across your health service provider organization and across
your country. For more details on how to organize an HTMS, refer to Guide 1.
28
Finances
To ensure that healthcare technology is utilized effectively and safely throughout its
life, your health service provider will need to plan and allocate adequate capital and
recurrent budgets. See Sections 5 and 6 for more advice on this.
In a government-organized system these funds have to be provided by government

budgets, while private systems or mixed systems must generate the required funds
from their customers, or from benefactors and donors.
Depending on your health service provider and country, your HTM Service may be
able to generate income by charging for services provided. Whether this income can be
used to further improve the HTM Service depends on the policies of the responsible
financing authority (such as the treasury or central finance office). Guide 6 provides
advice on this.
The Importance of Introducing an HTM Service

We have established the importance of:
◆ adopting standards for healthcare technology
◆ developing healthcare technology policies

◆ establishing systems to ensure the policy is implemented.
All these aims could be achieved if each health service provider practised healthcare
technology management (HTM) as part of the everyday life of their health service.
The best way to do this is to have an HTM Service incorporated into each health
service provider organization.
Box 2 (Section 1.1) shows that HTM provides a wide range of benefits. Guide 1
attempts to express this in terms of the sorts of savings that can be made if HTM is
effectively carried out. Taking maintenance as an example, we can see that it has not
only a positive impact on the safety and effectiveness of healthcare technology, but
that it also has two important economic benefits:
◆ it increases the life-span of the equipment
◆ it enhances the demand for health services, since demand for services is crucially
dependent upon the availability of functioning healthcare technology.
Healthcare technology that is out of order quickly leads to a decline in demand, which
will in turn reduce the income and quality of services of the health facilities. You will
lose clients if, for example, it becomes known that malfunctioning of sterilization
equipment may endanger the health of the patients. Similarly, patients will avoid
visiting health facilities that do not possess functioning diagnostic equipment.
29
Thus the justification for introducing an HTM Service is that it will benefit you
economically and clinically, by ensuring that healthcare technology continues to
meet the standards required throughout its working lifetime.
The activities of an HTM Service belong to the service provision function of health
systems. However, the government may wish to take a regulatory role and establish
regulations that guarantee that HTM occurs. To achieve this, it will be necessary
to have:
◆ a government body to provide regulations that will ensure the continued
performance and safety of healthcare technology throughout its life

◆ a control mechanism to check that all health service providers pursue these
healthcare technology management activities effectively
◆ legal or other sanctions that are enforceable if the rules are infringed.
The government body responsible for providing regulations could be the central
level of the national HTM Service. Each health service provider could then develop
its own HTM Service. It should involve a network of teams and committees that
enable HTM to be practised in all facilities. In order to establish an effective HTM
Service, you will need to provide sufficient inputs, such as finance, staff, workshops,
equipment, and materials. Only in this way will you get the outputs and benefits that
you require. For details of how to develop such an HTM Service, see Guide 1.
The organizational chart for the HTM Service will vary depending on the size of your
country and your health service provider organization, and whether you are just
starting out. However, Figure 7 provides an example of the relationship between
HTM Teams and HTM Working Groups (Section 1.1) that we envisage.
30
HTM HTM health
Team Working manage-
Central level
Group technical ment
assistance team
Workshop
technical
support
HTM HTM health

Zonal level
assistance team
Workshop
technical
support
Facility level HTM HTM health

Figure 7: Sample Organizational Chart for the HTM Service

– large ment
Group technical
assistance team
Workshop
technical
support
– small HTM HTM health

assistance team
31
How to Manage Change

The regulatory requirements presented in this Section may appear somewhat
idealistic, compared to the reality in many health systems. However, the aim is not to
highlight the deficiencies of existing systems, but to provide a blueprint for a
functioning healthcare technology management system. Hopefully, this will enable
you to get the right framework conditions in place, and thus improve the
effectiveness and the safety of your health services.
We are not recommending that your health service provider:

◆ throw out all their current HTM strategies and start again
◆ make sudden and sweeping changes that are likely to fail if they are over
ambitious.
Rather it is better to take a step-by-step approach, introducing changes gradually,

with a careful review process. To implement an HTM system with all the
complexities described in this Series of Guides will take several years, and to try to
achieve everything at once could be disastrous. However for healthcare technology
management to improve, it is important to act.
It is possible to write down all the correct procedures and yet still fail to improve the
performance of staff. To ensure that your HTM procedures are effective, it is
important for there to be good managers who can find ways to motivate staff
(Section 8). Simply ordering staff to implement new procedures usually does not
work. It is much better to discuss and develop the procedures with the staff who will
implement them. This could take the form of discussion, working groups or training
workshops. People who are involved in developing ideas about their own work
methods are more likely to:
◆ understand the objectives
◆ understand the reasons why processes are necessary
◆ be encouraged to change their way of working
◆ be more interested in making changes which result in improvement
◆ see that the aim of the HTM procedures is to improve their delivery
of healthcare.
We recognize that many readers will face difficulties such as staff shortages, poor
finances, lack of materials, a lack of influence and time, and possibly even corruption.
Introducing new rules and procedures into a system or institution that has no real
work ethic, or which possibly employs dishonest workers, will not have any
significant effect.
32
Therefore, strategies may be required to bring about cultural and behavioural

change. For example:
◆ when materials are short, instead of focussing upon breakages and loss, place more
emphasis upon the importance of staff working hard and putting in the hours
◆ favour good managers who are seen to be present and doing what they preach
◆ encourage an atmosphere where staff are praised for good work, rather than a
culture of judgement and criticism.
Introducing rules and administrative procedures alone will not be sufficient to bring
about cultural change. You will also need to find ways of increasing performance and
productivity, and acknowledging/rewarding good behaviour is essential. For example:
◆ it is better to break a tool while actively undertaking maintenance, rather than
breaking nothing but never doing any work
◆ it is better to break a rule in an emergency (such as withdrawing stocks from
stores), rather than stick to the rules and risk the possible death of a patient.
Annex 2 has some examples of useful reference materials. To bring about such
changes, you will require skills in:
◆ managing change
◆ staff motivation
◆ effective communication
◆ encouragement, and
◆ supportive training with demonstrations.
All parties involved in the network of HTM Teams and HTM Working Groups need
to participate in developing the HTM Service. This will encourage a sense of
ownership of the Service and its responsibilities, and will lead to greater acceptance
and motivation among staff. If you are short of skilled staff (such as technicians,
managers, planners or policy-makers), you may need to obtain specialist support to
assist with some of these tasks.
2.2 BACKGROUND CONDITIONS SPECIFIC TO

THIS GUIDE
Your country and health service provider may have existing regulating principles
and conditions which will affect, or can inform, aspects of your planning and
budgeting work.
You will need to find out whether the regulations and policies discussed in this
Section exist in your country and organization. If they do, it makes sense to follow
them. If such regulations do not exist, you will need to highlight these issues at the
central level of your organization, and continue to follow the advice provided in this
Guide at your level.
33
2.2 Background conditions specific to this guide
Responsible Management Authorities

If you work for a health service provider organization, you must conform to:
◆ any existing regulations and guidelines concerning equipment planning and
budgeting, which are produced by the central management body.
In addition, there may be professional bodies which provide guidance for their area
of expertise. For example:
◆ the National Board of Survey, which has regulations and procedures on
decommissioning and disposal of equipment. These cover the condemning,
boarding, and auctioning of equipment at the end of its life.
Responsible Finance Authorities

If you work for a health service provider organization, you must work within the
financial resources allocated to you. Thus you must conform to:
◆ the regulations and guidelines produced by the central Finance Office (for
example, the treasury in the government system), such as:
- any accounting policies and procedures covering budgetary processes
- any budgetary limitations and criteria set by the central level of your health
service provider (such as guidelines on maintenance expenditure as a
percentage of health facility operational budgets)
- any financial policies and procedures which govern stock management and
expenditure accounting
- any local regulations regarding co-financing schemes.
Central Plans for the Health Service

When making plans which will introduce changes to your work, your health facility,
or your district/region, you must conform to:
◆ the overall central plans and aims of your health service provider.
Individual health facilities and district authorities should not work independently of
the plan for the health service as a whole. In equipment terms, there are several key
areas where this especially applies:
The ‘Vision’ for the Health Service

As explained in Section 2.1, every health service provider needs a realistic Vision of
the services it can offer, so that it can decide what equipment it should own, and
prioritize the actions to take to develop its stock of equipment. Section 4.2
describes how to develop a Vision.
34
Your country and health service provider may already have developed central level
guidance such as Essential Service Packages. But many countries and organizations
may not have defined the functions for each level of healthcare delivery, or written
them down in a policy document. This makes it very difficult to plan, since there is
no framework on which to base decisions. Thus, you should conform to:
◆ any guidance from your health service provider on the direction of healthcare
delivery for your level of facility.
When developing Essential Service Packages, be careful to ensure that you can
afford the technology implications. For example, you may wish to improve equity of
access and think it ideal to move a service, such as CT scanning, from central level to
regional (provincial) level. But if there are five regions, you will require not only five
times the pieces of equipment, but also five times the qualified staff, consumable
items, support services and energy supplies. You may find instead that it is more
cost-effective to transport patients to the central unit. Thus the money might be
better spent on improving the central unit and the patient referral transport system.
There are many issues affecting service delivery in the future which are still being
aired in international discussion documents. For example, the changing disease profile
is likely to affect both care and equipment requirements. Also, controversies are being
examined for lessons learnt, such as the need in some countries to re-centralize in
order to be able to afford and manage services (see Annex 2).
Model Equipment Lists

Once you have drawn up a Vision for health service delivery, you can determine what
types of healthcare interventions to offer at each service level. Next, you must
define what equipment is required.
This is done by drawing up Model Equipment Lists, which describe what

equipment is essential for providing each healthcare intervention. (The process of
developing such lists is described in Section 4.3). When drawing up Model
Equipment Lists, you should conform to:
◆ any guidance from your health service provider on equipping levels for your facility.
Since Model Equipment Lists are linked to the healthcare interventions you carry
out, they will not necessarily be tied to specific rooms. However, when drawing up
Model Equipment Lists, it is also important to consult with architects, to determine
factors such as room size, accessibility and flow patterns, based on the function of
the room. Such minimum room standards ensure that the furniture and equipment
can fit into the space in an orderly and effective way. Your plans should include the
number of square metres, the requirements for water, electricity, light levels and any
other factors which could have an impact on equipment use and accessibility (see
Annex 2). These building aspects are often forgotten. Thus, you should conform to:
◆ any guidance from your health architects on the space requirements for your
Model Equipment Lists.
35
When planning equipment, it is also important to remember the other capital

investments (outside the Model Equipment List), such as training requirements,
and buildings and utilities (power, water, waste management). These investments
are significant and often are a pre-condition, before you can start to make wise
equipment investments. Thus, you should conform to:
◆ any guidance from your health service provider on the other capital investments
arising from your equipment plans.
Purchasing, Donations, Replacement, and Disposal Policies

To avoid wastage, you need to ensure that equipment is acquired in a rational and
planned way. Equipment should be obtained according to good policies and
procedures, covering both the disposal and replacement of existing equipment, and
the purchase and donation of additional items. (The development of such policies is
described in Section 4.4). Thus, you should conform to:
◆ any policies of your health service provider which guide you on valid reasons for
replacing equipment and obtaining new items.
Where possible, you should introduce an element of standardization when acquiring

equipment in order to gain technical, financial, logistic, procedural, and training
benefits (Section 2.1). However, government or institutional procurement
guidelines often do not allow direct procurement, but stipulate procurement
through tenders based on generic specifications (see Guide 3). In such cases, the
only way to introduce a level of standardization is to procure for many health
facilities at one time. For example, the whole country, region, or organization might
replace all their suction pumps at the same time and a standard can evolve. Thus,
you should conform to:
◆ any standardization policies of your health service provider.
Procurement on an individual facility basis will almost certainly produce many one-
off examples of different types of equipment which are not economical to maintain.
To avoid such issues, it is very important to combine forces with other facilities
when planning and purchasing new equipment. In order to make the planning of
such procurement possible, it is almost mandatory to have a computerized inventory
and procurement system. Thus, you should conform to:
◆ any strategies introduced by your health service provider for collaboration
between bodies during planning and procurement.
36
Generic Equipment Specifications

Once you have developed Model Equipment Lists, it will be necessary to describe
the equipment required in detail. This is necessary to ensure that you acquire the
types of equipment you want (this applies equally whether your equipment is
received through procurement or via donations). Section 4.5 gives further advice on
how to write such Generic Equipment Specifications. Thus you should conform to:
◆ any equipment specifications developed by your health service provider.
Generic Equipment Specifications will also enable you to conform to the standards
set by government, and to continue to meet the standardization policy of your health
service provider.
Availability of Management Skills

This Guide presents a detailed and complete description of the planning and
budgeting process. To carry out the procedures outlined here, you will require a
reasonable number of well trained staff. In many countries, this level of management
skills may be available at national level or in large hospitals, but will be a problem at
district level.
The current decentralization efforts in the health sector will bring about significant
changes in the management and procurement of healthcare technology. District
managers may be asked to quantify and specify all future procurement activities.
This task is large and complex and the present skills of district managers in some
countries will be inadequate.
For these reasons, it may be necessary to:

◆ encourage planning, budgeting, and procurement tasks to be carried out at central
level for those facilities and service levels which cannot undertake the whole
management process themselves
◆ encourage district managers to understand the process and be aware of what they
are able to manage, and where they need help.
Economies of Scale
With an improved management system, decentralization can promote accurate and
timely decision-making. However, there will still be a need for central policy guidance
on equipment levels and technical specifications, because it will not be economical to
develop such knowledge at district level. This is an example of how the economy of
scale for technical knowledge will challenge the decentralization process.
A second example of a challenge to decentralization is the economy of scale required in

procurement. Procurement of small quantities increases the initial cost and the life-
cycle costs of equipment (Section 3.3), because you cannot benefit from the savings
that bulk-buying offers. More details of procurement options are provided in Guide 3.
37
When making a needs assessment for one hospital, you are likely to arrive at low
quantities of a broad variety of equipment. So undertaking calculations at facility
level will not enable you to benefit from economies of scale. Instead, by combining
procurement for several facilities at the same time, and gaining the resulting
standardization, you can obtain significant advantages. These include better prices
for new equipment and spare parts, shared training costs and improved after-sales
commitment from the supplier.
Thus it is preferable to:

◆ undertake equipment management and needs assessment at district or regional
level, and merge procurement needs for a number of facilities or districts. This
will result in the ideal combination of accurate management and procurement
advantages, proportional to the economy of scale.
You may face problems with this rationalization and savings strategy when donors
target funds at individual facilities or districts. Thus it is preferable to:
◆ ensure donors follow your Model Equipment Lists, Generic Equipment
Specifications, and standardization policy, in order to overcome the drawbacks.
Box 4 contains a summary of the issues covered in this Section.
BOX 4: Summary of Issues in Section 2 on Framework Requirements
Government ◆ actively regulates health services, whether they are delivered by public providers,
private providers, or a mixture of the two
Quality Health Services
◆ develops checking systems and legal sanctions for infringement of health

regulations
◆ adopts suitable standards for quality health services, in general
◆ specifically for healthcare technology, adopts standards for:
- design, development, and manufacturing
- performance and safety
- use and training
- waste disposal
◆ develops donor regulations to ensure all equipment received through foreign aid
and donations also comply with the standards
◆ establishes public or quasi-public supervisory bodies to enforce regulations and
standards.
Continued opposite
38
Section 2 summary
BOX 4: Summary of Issues in Section 2 on Framework Requirements (continued)
Ministry ◆ develops national policies for health services

of Health ◆ specifically develops a Healthcare Technology Policy to cover all healthcare
technology management activities including:
- a Vision
- an element of standardization
- the provision of maintenance
- provision of finances for all HTM activities
- the organizational structure for an HTM Service
◆ regulates on these issues (if required)
develops an HTM Service made up of a network of teams and working groups
Quality Health Services
◆ uses the central level of the HTMS as the national regulatory body, if necessary, and to
ensure that HTM policies are implemented
◆ provides sufficient inputs to ensure the HTMS is effective
◆ uses strategies to manage the changes involved carefully, so that they can be successful.
All Health ◆ conform to regulations and guidelines provided by government

Service ◆ conform to the standards set by government
Providers
◆ follow the policies of the Ministry of Health if regulated to do so
in general
◆ develop their own internal Healthcare Technology Policy and expand strategies
◆ develop their own HTM Service made up of a network of teams and working groups,
with sufficient inputs to ensure it is effective, in order to ensure that HTM policies
are implemented
◆ follow MOH regulations on the HTMS if regulated to do so
◆ implement strategies to develop skills in managing change, staff motivation, effective
communication, encouragement, and supportive training with demonstrations
◆ introduce rules and procedures using discussion, working groups, training workshops,
etc. with the staff that will implement them
◆ include all parties involved in the network of HTM teams and working groups in the
development of the HTMS
◆ introduce changes to HTM step-by-step, with a careful review process.
Continued overleaf
39
Section 2 summary
BOX 4: Summary of Issues in Section 2 on Framework Requirements (continued)
All health staff ◆ Conform to regulations and guidelines provided by relevant bodies on:
and managers
- equipment planning and budgeting
- decommissioning and disposal of equipment
- accounting policies and procedures
Planning and Budgeting
- budgetary limitations and criteria set for different activities

- financial policies and procedures that govern stock management and
expenditure accounting
- co-financing schemes.
Health Service ◆ Provide central guidance on:

Providers
- the Vision for the health service and Essential Service Packages
- equipping levels for your facility (Model Equipment Lists)
- purchasing, donations, replacement, and disposal policies
- the development of Generic Equipment Specifications.
Managers ◆ only undertake planning and budgeting at suitable decentralized levels in your
(at each organization where sufficient management skills are present
level of your
◆ use economies of scale to your advantage by:
organization)
- making use of technical skills and guidance from levels where the knowledge exists
- combining forces with other levels to undertake needs assessment, and
bulk-buy equipment and supplies in order to gain from procurement savings
and standardization.
40
3. How to discover your starting point – planning tools I
3. HOW TO DISCOVER YOUR STARTING

POINT – PLANNING TOOLS I

In order to manage your equipment effectively, you need to have a clear picture
of your current stock and supplies – it is very difficult to manage an unknown.
You need to know the value (quantity and cost) of your equipment, so that
financial planning is not guesswork. You also need to understand your likely
expenditure on equipment-related activities such as training and maintenance.
Finally, to help you budget effectively, you also need to determine your rate of
use of equipment. In this way, you can draw up a realistic estimate of the
inputs you need.
Before you can carry out any planning or budgeting, it is necessary to know where you
are starting from. Thus you need some baseline data which will help you to
understand your present equipment situation.
To analyze your equipment situation effectively, you need to draw upon some
important ‘planning tools’. This Section covers four such tools, and discusses how to
determine your starting point by:
◆ keeping an up-to-date Equipment Inventory (Section 3.1)
◆ knowing the value of your stock of equipment (Section 3.2)

◆ having budget lines that are sensitive enough to show equipment expenditures
(Section 3.3)
◆ discovering your rate of use of equipment-related consumable items (Section 3.4).
Some health providers may already know a great deal about their equipment. This
will vary, depending on how much planning and budgeting of equipment has already
been carried out. Your level of equipment knowledge will depend upon:
◆ your country

This Section describes how to undertake one-off exercises to establish the tools
needed to plan and budget for your equipment. Different activities are described for
the different health service levels. This work will help you to analyze your own
present situation.
How to use these tools in the planning and budgeting process is described in Section 7.
Section 8 discusses how to monitor and review these tools.
41
3.1 The equipment inventory
3.1 THE EQUIPMENT INVENTORY

3.1.1 Understanding Inventories
One planning tool you need is an Equipment Inventory. This provides you with all
the details of the equipment that you currently own.
Usefulness of Having an Inventory

It is very important to know all about your current stock of equipment, so that:
◆ any allocation of resources is an objective assessment, and not guesswork;
(therefore budgets are based upon the actual quantity of equipment owned)
◆ you can manage equipment effectively, because you are not dealing with unknown
quantities; (for example, the HTM Manager knows how many suction pumps to
include in the planned preventive maintenance programme)
◆ you can calculate what you can afford to operate or run; (therefore you do not
overestimate or underestimate the consumables required, and set your recurrent

budgets accurately)
◆ you can develop realistic plans for the future, because you know your current
equipment situation; (therefore you do not waste funds procuring new equipment
while neglecting the replacement of existing essential items).
As an example, we can consider the importance of an inventory for planning

maintenance activities:
◆ if you want your equipment to function, you must maintain it
◆ if you want to maintain your equipment stock, you must budget for maintenance
◆ to be able to budget adequately, you must have an idea of the value of what you own.
Did you know?

Knowing what you own means:
knowing - what there is type/sorts
- how much of it there is quantity
- where it is location
- what condition it is in status
- how far it is in its life-cycle age/expected life
having - some way of updating the information accuracy
The method for doing this is to keep an Inventory of your equipment.
42
3.1.1 Understanding inventories
An Equipment Inventory is an important tool because it enables you to:

◆ identify the shortfalls in your equipment stock (once you have developed a Model
Equipment List to compare it to – Section 4.3)

◆ implement your equipment replacement and disposal policies (Section 4.4)
◆ implement your equipment purchasing and donations policies (Section 4.4)
◆ calculate the new value of your equipment stock (using up-to-date prices) which
will be used for calculating your budgets (Sections 3.2, 5 and 6).
What is an Inventory?
An inventory can consist of several separate lists of specific types of equipment
(such as medical equipment, plant, furniture or workshop tools), or a combined list
of all equipment types.
Box 5 (overleaf) shows the sort of information to gather when taking the
equipment inventory as a minimum. Additional information can be gathered and
either kept with the inventory or separately (see Box 6). Your inventory can be:
◆ simply a compilation of these record sheets, containing lists of the equipment
found in each department

◆ or you can enter the information gathered onto an Inventory Form for each piece
of equipment
◆ or you can enter the information into a computer program.
Such a listing can then be organized and sorted in many ways. This is easiest if you
have a computerized inventory, although sorting information is possible with a card
index system. You can sort the information in ways which are of use to you, such as:
◆ alphabetically by product (for example, defibrillator, microscope)
◆ by location
◆ by manufacturer
◆ by use/function
◆ by age
◆ by your inventory code number.
If your Equipment Inventory covers a wide range of facilities or many items, you may
have to prioritize what to include on the listing. For example, are you going to list every
scalpel and stethoscope? Or can you simply list the number of different surgical sets
(so long as the contents have been agreed), or only list items above a certain value?
43
44
BOX 5: Record Sheet for taking the Equipment Inventory (showing the basic essential data to gather)
Description:
Date Inventory Taken:
Facility: Department: Section:
Location/ Type of Inventory Name of Model name Manufacturer's Year made Supplier Status/ Your property
Room equipment code number manufacturer and/or number serial number or bought bought from Condition or leased?
(your own (factory

number) number)
Example 1:
Facility: Green Rural Hospital Department: Maternity Section: Labour Ward
Examination Foetal doppler GR 123456 HNE Diagnostics FD II HNE-863b 2000 AB & Sons working OK Leased
Delivery suction pump GR 123029 Eschmann VP35 760-819-MN 1999 BCD Company working OK Own
Example 2:
Facility: Blue District Hospital Department: Kitchen/Canteen Section: Kitchen
Cooking area stove BD 198765 Vulcan model 6 435R/Z6 1995 Vulcan Ltd replace 1 plate Own
Food prep refrigerator BD 198123 GEC MCC 660 1357-2468C 1990 Vulcan Ltd OK but old Own
Experience in Kenya
The Aga Khan Foundation (private) hospital found that if they listed everything, the
contents of their Equipment Inventory would be quite comprehensive. Thus they decided
to agree on an accounting definition of what should be called a ‘capital item’. For
equipment, they chose a ‘capital item’ to be anything which:
◆ has a cost of US$250 or more
◆ has a life of at least one year; and

◆ is a distinct tangible object.
Other information about the equipment should also be kept on file, but does not
necessarily have to form part of the inventory. Box 6 shows the types of other data
that need to be kept. You may choose whether to keep this information on the
inventory itself, or to enter it into the maintenance Service Histories for the
equipment (see Guide 5).
One factor which will help you in deciding what data to include in the columns of
the record sheet, is the level of knowledge of those filling in the sheet. If there is
data which is kept by a different department (such as the purchasing department),
or is only known by specialists (such as HTM Managers), this information could be
kept in a separate record system.
BOX 6: Other Types of Equipment Information to Keep
◆ the address of the manufacturer and local agents
◆ the address of the supplier and local representative
◆ technical ratings
◆ date when the warranty expires
◆ the price paid
◆ any external funding agency involved
◆ stocks of consumables, accessories, and spare parts received
◆ results of inspection tests undertaken on commissioning
◆ the frequency of planned preventive maintenance required
◆ details of any maintenance contract and maintenance contractor
◆ maintenance history.
45
3.1.2 Establishing the equipment inventory
An initial exercise will be required to establish both the Equipment Inventory and
the inventory code numbering system. However, decisions on code numbers should
not delay the establishment of the Equipment Inventory. Specialist support may be
required to assist with these processes.
After the initial exercise, the upkeep of the Equipment Inventory and the inventory
code numbering system is part of the routine work of the HTM Teams, as part of
their equipment management activities (Section 8.1).
3.1.2 Establishing the Equipment Inventory

Who is Responsible for the Equipment Inventory?
Many health service provider organizations have a General Inventory for their
facilities kept by Stores personnel. This covers everything found in each
department (including such items as furniture, plastic and glassware, waste bins,
notice boards, wall clocks). A record of the contents of each room is kept on a card
(often found on the back of the door), and a paper copy is held in the Stores. Items
are often painted with their Stores code number.
However, the details contained within this General Inventory are generally
insufficient to enable equipment or maintenance plans to be made. Also, the data is
not easily updated or manipulated on a computer. For this reason, a separate record is
required, which is known as the Equipment Inventory. This covers technical
details and is restricted to items of equipment – in other words, those items which
require maintenance throughout their lives.
Preference
You should aim to introduce an equipment inventory system that is uniform across the whole
of your health service organization. This is preferable to allowing each facility to collect
different details and use different forms (though even that is better than having no inventory
at all). If all facilities collect the same type of information, the data can be compiled at some
point to form an inventory for the whole organization, and can more easily be entered into a
computer system using common software.
46
Who? Takes what action?

HTM Teams (Section 1.1) Manage the equipment inventory
Which level? Takes what action?
Central HTM Team - Ideally, designs the inventory system (the forms
plus the data collection process).
- Probably computerizes the system as the team
must be able to manipulate data for the whole
health service.
- Shares a paper or computer version of the
inventory with each facility and district/region.
Facility and/or District Gather the data, keep a paper copy of their
HTM Teams inventory, update the information annually, and feed
back any changes to the centre.
Tip • Your health service provider might not have developed a service-wide inventory. Do
not let this prevent you from having an Equipment Inventory at your health facility.
You can encourage your central HTM Service to establish an inventory system, but in
the meantime you can gather your own inventory data and use it for planning purposes.
How to Create the Inventory

An initial inventory should take place, in which a team of staff (including technical
personnel) visits each department, physically checking each piece of equipment,
and writing down all the details. Box 5 shows an example of a record sheet which
can be used for taking an inventory. A list of tasks involved is highlighted in Box 7.
The amount of work involved in undertaking such an exercise should not be
underestimated. This is a large task, since every room, cupboard, drawer, worktop,
shelf, and store room must be investigated. If you are undertaking an inventory for
the first time for a whole district or country, you may need to hire specialist support
to help you with the task.
The inventory can consist of a manual paper record or a computerized file. It does
not matter which, because the sort of data that you must record is the same whether
you are designing the layout of a card or the fields on your computer screen. The
master copy of the Equipment Inventory can be stored on computer, so that data
manipulation and updating is easy. However, for daily referral to the inventory, hard
copy print-outs can be used.
Annex 2 provides references which discuss the possibility of computerizing your

inventory, and provides details of some inventory software products that are available.
To ease the workload for the small HTM Teams, support from secretarial and
computing staff can be used to assist with data entry.
47
48
BOX 7: Taking the inventory
Body Responsibility Activity People involved

HTM Service Creates and updates the Organizes the gathering of inventory data. Either by:
Equipment Inventory ◆ facility staff for their own facility
◆ district/regional staff for the facilities in their
district/region
◆ central staff for the health service as a whole
◆ using specialist help.
Inventory Team Carries out the Equipment Visits each department in the health facility, and: Due to the workload and knowledge required, it
Inventory at each facility ◆ looks in all rooms, cupboards, etc. is useful for the team to be made up of:
◆ physically checks all equipment for the details ◆ two maintenance staff (from the relevant
required (see Box 5) HTM Team)

◆ fills in the Equipment Inventory Record Sheets ◆ a senior equipment user from the facility
(see Box 5). ◆ a member of staff from the department being
If existing records are available: studied (who changes as you move from
◆ modifies or expands the information as department to department).
necessary to cover new items As a bare minimum you could try using one
◆ fills in any gaps member of maintenance staff and one member

◆ corrects entries of departmental staff (who changes as you move
◆ updates data in order to make the Equipment from department to department).
Inventory as accurate as possible.
HTM Teams Compile the Equipment ◆ Enter the data gathered, either onto an Make use of trained technical staff and
Inventory. inventory card or a computer screen, for each secretarial/computing support to assist with data
Make hard copies. individual machine. entry.
◆ Create summaries, prepare and print out hard
copies
◆ Provide a copy of the Equipment Inventory to
the Stores Controller for inclusion in the
General Inventory held by Stores.
Continued opposite
BOX 7: Taking the inventory (continued)
Body Responsibility Activity People involved

Central-level Develops the Equipment ◆ Uses the computer software packages required Makes use of support from staff trained in
HTM Team Inventory as an active (regularly for this purpose (for example, word-processing keeping computerized records.
updated) computer file, as well as spreadsheets or specific commercial inventory
a hard copy print-out. products – see Annex 2), which staff have been
Analyzes the Equipment trained on.
Inventory for planning purposes
(Section 7.1).
49
Periodic Updating of the Inventory

An inventory is an active record – in other words, it must be kept up-to-date if it is to
be of any use. Data used for planning purposes is of little use if it is out of date. You
should update your inventory periodically throughout the year, whenever new data is
received which is relevant to the inventory. There should also be a formal annual
updating process (Section 8.1).
The HTM Teams should use the many opportunities during their work throughout
the year to regularly gather data for updating the Equipment Inventory, such as:
◆ when new equipment purchases and donations arrive, information will be entered
onto the Equipment Inventory when the equipment is commissioned and the
‘Acceptance Test Logsheet’ is completed (see Guide 3 on procurement and
commissioning)
◆ whenever equipment is serviced or repaired throughout its life (see Guide 5 on
maintenance management)
◆ whenever equipment is taken out of service (see Guide 4 on operation and safety).
Possibly every month or quarter, HTM Managers should oversee the inventory
updating process and make sure the following happens:
◆ A record of any changes is kept on the hard-copy print-out of the Equipment
Inventory.
◆ The computer inventory file is regularly updated by entering into the computer
any comments from the hard-copy print-out, as well as removing from the
inventory any ‘written-off ’ (condemned) items (see Guide 4).
◆ A formal annual inventory update is organized (Section 8.1).
3.1.3 Establishing Inventory Code Numbers

What is an Inventory Code Numbering System?
Inventory codes are numbers that the HTM Service uses to label each separate
piece of equipment, so that individual machines can be identified from among many
similar items. It is important to be able to do this so that, for example, you could
consider the service history (see Guide 5) of a specific suction pump, for example,
compared to the performance of all suction pumps in general.
Various types of inventory code numbering systems can be used, and Box 8 shows
the advantages and disadvantages of the various options. It is possible to make your
system as sophisticated (complicated and informative) or as basic (simple but less
informative) as you like.
50
3.1.3 Establishing inventory code numbers
BOX 8: Types of Inventory Code Numbering Systems
Options Advantages Disadvantages

Basic Sequence Number
The inventory code numbers simply Ideal for computerized By looking at the number you cannot
start at ‘one’ and continue endlessly inventories. tell anything about the machine.
into the thousands. Each new item is The number is used to You need to have a centralized
simply allocated the next number on search the computer master list to see which is the next
the list, whatever type of equipment database to reveal all the number to be allocated.
it is or wherever it is going to be data stored about that
located. particular machine.
‘Speaking’ Numbers
This is a system where a code number From the code number The list of numbers which make up
is used, which tells you something you can identify the different parts of the code (e.g. 199
about the equipment. Different parts location of the = suction pumps) has to be agreed,
of the code are used to mean certain equipment, the allocated, and understood by the
things. For example, the code could equipment type, and HTM Teams.
be T1 199 02. In this case, the first which specific machine
If the location of the equipment
part of the code (T1) tells you about you are dealing with.
changes, the number will also have to
the location (Theatre 1). Speaking numbers can be be altered.
The second part tells you the made with as many parts
equipment type (199 being your as you like which tell you
code for suction pumps), and the additional things about
third part identifies the individual the equipment (such as
machine (i.e. your second suction the facility or the region)
pump in Theatre 1).
A Barcode
Commercial barcode stickers are You don’t need to paint By looking at the barcode, you cannot
purchased, which can be read by large sequences of tell anything about the machine.
barcode readers. The information is numbers onto the
It can only be used with a
then transferred to a computer. equipment.
computerized system.
Software programming is required to This is a computer-based
You need a regular supply of barcode
link the reading from the barcode to system.
stickers, barcode readers, and a
details about the equipment.
software program.
51
Country Experiences
The central health ministry in Malawi uses a basic six-digit sequence number that refers
to the equipment record kept in a computerized database. Whenever work is undertaken
on a piece of equipment, typing in the basic number into the computer means that the
inventory details and maintenance history of that item are displayed on the screen.
The Central Maintenance Department of the public health service in El Salvador developed
a sophisticated 13-digit inventory code numbering system, which contained details of the
type of equipment and its location. This required a great deal of knowledge (technical,
medical, and administrative) among the staff responsible for allocating the numbers.
However, using the skills of the knowledgeable personnel, they were able to develop a
small code booklet, which is now used by technicians to look up the correct numbers.
The central health ministry in Namibia decided to stick barcodes onto their equipment,
instead of having an inventory code number painted onto each item. They acquired a
commercial barcoding system to program and install on their computers, and scanners
with which the technical staff can read the codes.
Who is Responsible for Inventory Code Numbers?
Preference
You should aim to introduce an inventory code system that is uniform across the whole of
your health service organization. This is preferable to allowing each facility to use a different
code system (though that is better than having no system for identifying equipment at all).

HTM Teams Manage the inventory code numbering system
Central HTM Team Ideally, designs the inventory code numbering
system, and shares it with each facility and
district/region.
Facility and/or District
HTM Teams Implement the system, and put the numbers on the
Tip • Your health service provider might not have developed a inventory code numbering
system. Do not let this prevent you from using some method of identifying
equipment at your health facility. You can encourage your central HTM Service to
establish an inventory code numbering system, but in the meantime you can label
your own equipment.
52
How to Create the Inventory Code Numbering System

The HTM Service should undertake an exercise to develop an inventory code
numbering system, and should consider the options available as shown in Box 8.
Specialist support may be required to assist with these processes. Once a system has
been set up:
◆ Existing machines and maintenance records (see Guide 5) must be labelled with
their inventory codes (stickers or marker pen can be used).
◆ New equipment must be allocated a code during the commissioning and
acceptance testing process (see Guide 3).
Tip • Never label your surgical instruments by scratching or etching letters onto them
(such as the name of the facility). This removes the protective layer and causes dirt
and water to collect in the grooves, which results in corrosion, staining, or rusting.
Rust weakens instruments and will eventually cause them to break. Also the grooves
make it very difficult to decontaminate the instruments adequately (see Guide 4).
3.2 STOCK VALUE ESTIMATES

It is preferable to have a planned approach to the financing of healthcare technology.
Many calculations which can help you to decide the finances required for equipment
are based on a percentage of the equipment stock value. For example, in Section 6.1
when calculating maintenance costs for your equipment you will use an internationally
recognized percentage of your equipment stock value. This is necessary because your
maintenance budget must be based on the capital value of your equipment.
If you do not know the value (quantity and cost) of the equipment you own, any
planning is likely to be purely guesswork. Therefore it is necessary to calculate your
Equipment Stock Value (your second planning ‘tool’). Once you have worked out
this figure, any other calculations you make will be directed towards providing the
resources needed to sustain your existing stock.
In many countries no equipment stock values have been estimated, usually because
no equipment inventories exist. This means that all equipment budget allocations
are based largely on guesswork, rather than being based on calculations of the real
finances required to keep equipment functioning.
Tip • When calculating stock values, it is best to use current and up-to-date prices for the
equipment. It is much more difficult to calculate the actual present value of the stock
because you will have to allow for depreciation in value over time, and decide which of
the many depreciation methods to use. Also, by basing your calculations on the price
you originally paid for the equipment, you will always be out-of-date. By calculating
Equipment Stock Values ‘as new’, your replacement and maintenance estimates will
always be linked to current prices.
53
3.2 Stock value estimates
Who is Responsible for Stock Value Estimates?

The HTM Working Group, Is responsible for developing equipment price lists
or possibly a smaller pricing and stock values.
sub-group (Section 1.2)
Any level of the health Can develop stock value estimates.
service (central,
region/district, facility)
How to Make Stock Value Calculations

Anyone can develop stock value estimates if they have access to two things:
◆ the Equipment Inventory (Section 3.1)
◆ a Reference Equipment Price List.
A Reference Equipment Price List is useful as you can look up the typical
approximate prices for any type of equipment. A list of possible types of
equipment, together with their expected product lifetimes, is given in Annex 3.
In the same way, you can also develop a list of typical prices against different
equipment types. You can develop this by:
◆ starting slowly with the prices of recent and known purchases
◆ building it up over time as you get further quotes
◆ researching current prices over time, for example on the internet (see Annex 2).
The next step is to calculate equipment stock values. Details of how to do this are
given in Figure 8.
54
Figure 8: How To Estimate Total Equipment Stock Values
Process Activity
The HTM Working Group (or its pricing sub-group) at facility, district/regional, or central level:
Use purchase contracts,

Gathers data on current supplier information, data
equipment prices from service contracts,
manufacturers’ websites etc.
Compiles a Reference List typical prices for

Equipment Price List different equipment types.
Makes a stock value Use one of the following

estimate for your health three calculations for your
facility, or each facility type facility:
Estimate the major expensive equipment

If you want a rough categories (for medical equipment, plant,
estimate of the ‘new’ furniture, etc.) for the health facility. Then
stock value multiply their approximate numbers by the
reference prices, as shown in Box 9
If you want a more Cost the Equipment Inventory (Section 3.1)

exact estimate using the reference prices
If you want an Cost the Model Equipment List for your

estimate for the facility (Section 4.3) using the reference
future prices
Take the stock value for a facility type and

When making estimates for multiply it by the number of facilities of that
more than one facility: type in your district, region, country, or
organization.
Improves planning and Ensure the correct stock

budgeting value is always used for
planning and budgeting
purposes (Sections 5 and 6).
Ensures the information is Revise the prices regularly in

kept up-to-date order to provide a database
of current equipment prices.
Revise the stock values

periodically (Section 8.2).
Box 9 shows a rough estimate of equipment stock values by equipment category, for
an imaginary 120-bed district hospital. We recognize that, in some countries, the
contents listed would be for a larger hospital, or for a hospital offering secondary level
healthcare services.
55
BOX 9: Example of Equipment Stock Values for a 120-bed District Hospital (in 2003)
Medical Equipment US$

X-ray machines (one suite, one mobile) and film processors 250,000
Anaesthetic machines with vaporizers, and anaesthetic ventilators (three theatres) 110,000
Laboratory equipment, assorted 120,000
Operating tables (one each for three operating theatre suites) 90,000
Operating lights (one each for three operating theatre suites) 50,000
Infant incubators (six) 40,000
Transport incubators (one) 15,000
Monitors (one each for three operating theatre suites) 60,000
Defibrillators (one) 20,000
Diathermy units (one each for three operating theatre suites) 45,000
Ultrasound scanner (one for maternity cases) 15,000
Beds (120) and hospital furniture 200,000
All other medium to low technology medical equipment and instruments 200,000
Plant
Autoclaves (two large units) 25,000
Laundry equipment (one small set) 165,000
Incinerator (one) 70,000
Kitchen equipment (one small set) 45,000
Air-conditioning (10 individual units) 25,000
Mortuary (nine-body capacity) 20,000
Refrigeration (eight individual units, one cold room) 10,000
Electrical generator (one small set covering the whole facility) 50,000
Electrode boiler (one small set) 45,000
Water storage and treatment tanks 20,000
All other various plant items such as geysers, pumps, compressors 100,000
Assorted
All other furniture and office equipment 250,000
Vehicles (three) 90,000
Communication equipment (telephones or radios) 10,000
Total 2,140,000
There will also be the buildings, and service installations such as the plumbing, sewage, and electrical
distribution routes.
56
3.3 Budget lines for equipment expenditures
3.3 BUDGET LINES FOR EQUIPMENT EXPENDITURES

If you want to plan the finances for your equipment correctly, you must have:
◆ a clear idea of what you currently spend, and
◆ a realistic estimate of what you need.
To do this, it is necessary to have expenditure records of sufficient detail to enable

you to identify equipment-related costs.
By introducing Budget Lines for Equipment Expenditures, you can record and
monitor the many different ways in which money is spent on equipment. This
planning tool means that you will be able to analyze the financing required adequately.
In many countries it is very difficult to identify what is spent on equipment, as there

are no specific equipment expenditure records. Nor is it possible to analyze in any
detail how funds are being spent, because of the ill-defined structure of health
budgets (both centrally and at facility level).
Country Experiences
Many countries face the following problems with analyzing their equipment expenditure:
◆ Running costs of equipment (i.e. consumable costs) cannot be identified as they fall
under a recurrent budget code covering all general and medical supplies.
◆ Maintenance costs for medical equipment cannot be identified as they fall under a
budget code which covers maintenance of everything – buildings, vehicles, office,
plant and general equipment.
◆ Planned development expenditure on plant and large installed items of medical
equipment (such as X-ray machines) cannot be identified as they are rolled into total
budget allocations for construction costs.
◆ Budgets for the replacement and maintenance of the buildings and plant of the
government health service are allocated to the Ministry of Works, but they cannot be
identified for the Ministry of Health as the budgets are not divided by facility or even by
client ministry.
There are a variety of costs related to healthcare technology, and most of them are
hidden. This can be illustrated by using the image of an iceberg as shown in Figure 9.
An iceberg is known for only having a small portion of its bulk showing above water,
with the vast majority of its bulk hidden dangerously below the surface. All of these
expenses together are known as the ‘life-cycle costs’ for healthcare technology.
57
Figure 9: The Iceberg Syndrome of Life-Cycle Costs for Healthcare Technology
Purchasing
costs
Maintenance Transport and

costs installation Cost of recording
costs and evaluating
Operating
data
costs
Costs of
Training Removal Administration
Staff costs from service and Supply
costs costs
Source: Damann, V. and H. Pfeiff (eds), 1986, ‘Hospital engineering in developing countries’,
GTZ, Eschborn, Germany
As we have illustrated, there are many different equipment-related costs, and it is

common for only the purchasing costs to be remembered and allocated. It is difficult
to plan if:
◆ the various spending allocations cannot be specifically identified or monitored
within a facility’s budget, and are lost among other expenditures

◆ central budgets do not show how these funds for equipment are allocated to
individual cost centres (facilities, districts or health service providers).
Therefore, it is important to have budget lines (or sub-divisions) for each type of
equipment expenditure, at each service level.
Different Types of Expenditure

It is important to recognize the different types of expenditure for equipment and
what they are used for:
◆ Capital Funds are required to cover large one-off expenses. They are normally
planned for annually. The sorts of expenses covered by capital funds depend on
the size of the task and whether it is linked to the purchase of new equipment.
58
They usually include:

- replacing existing equipment
- buying additional equipment
- pre-installation work (site preparation and associated lifting and warehousing
expenses)
- support activities so you can start to use your purchases and donations
(installation, commissioning, and initial training)
- rehabilitation of equipment and the fabric of buildings which will be major works
and require large sums of money.
◆ Recurrent Funds are required to cover smaller regular expenses in order to keep
equipment functioning and running. They are normally planned for on a weekly or
monthly basis. The sorts of expenses covered by recurrent funds depend on the
size of the task and whether it takes place at times other than the purchase of new
equipment. They usually include:
- buying consumables for equipment operation
- buying spare parts and technical support for equipment maintenance, repair, and
minor works
- administrative expenses for equipment operation and maintenance services,
including energy costs
-training expenses for ongoing skill-development requirements.
In order to be able to monitor the different allocations and expenditures for these
equipment requirements, you will need to develop a variety of different budget
elements (or sub-divisions). These will need to be presented for each cost centre
(facility, region/district, or health service provider)
Tip • Whenever equipment is purchased it is essential to budget for its running costs.
Therefore, there must be a link between the budget lines for planned capital
expenditure and recurrent budget estimates for maintenance, consumable items,
and training.
We recognize that many poor countries find it difficult to set aside funds for
equipment needs from the small recurrent budgets available, as they are continually
re-allocated to meet other prioritized needs. This is especially the case if primary
healthcare is the priority of health services, and public health programmes take
precedence over institutional care services.
59
Experience in Ghana
Seventy per cent of the capital budget for the Ministry of Health (MOH) is funded from
external sources, and these capital funds are more readily available than funds from the
recurrent budget. Thus the MOH has adopted a strategy that links more of the ‘life-cycle
cost’ of equipment (daily operation, maintenance, and administrative needs for running
the equipment) into the capital budget over a number of years.
It has achieved this by considering these running costs as part of the ‘total cost of
ownership’ (purchasing cost) of the equipment which can be covered by the capital
budget. In this way, Ghana ensures that the cost of using equipment is covered for a few
years after commissioning. In the meantime, the recipient facility accumulates enough
monies from their internally generated funds so that they can support the equipment after
this initial grace period is over.
Who is Responsible for Creating Budget Lines?
Preference
Your health service provider should develop a budgetary system containing a variety of budget
elements for different equipment expenditures, which can be used across the whole of the
health service.

Finance Officers Develop the new budget lines.
Any level of the health Can develop budget elements that will show
service (central, how money is being spent on the different
region/district, facility) equipment expenditures.
Tip • Your health service provider might not have developed a budgetary system with
various equipment-related budget elements. Do not let this prevent you from doing
so at your health facility or district level. You can encourage your health service
provider to do this centrally, but in the meantime you can start analyzing how you are
spending your money.
How to Create Budget Lines for Equipment Expenditure

It is possible to develop budget elements that will show how money is being spent
on the different equipment expenditures. Box 10 provides some strategies
necessary to do this.
60
BOX 10: Strategies for Developing Budget Lines for Equipment Expenditure
People Responsible Action

Finance Officers, at all levels Establish different budget lines (sub-divisions) as itemized below:
of the health service (central, a. capital funds to cover equipment replacement (depreciation)
region/district, facility)
b. capital funds to cover additional new equipment requirements
c. capital funds to cover support activities which ensure equipment
purchases can be used (installation, commissioning, and initial training)
d. capital funds to cover pre-installation work for equipment purchases
e. capital funds to cover major rehabilitation projects
f. recurrent funds to cover equipment maintenance costs, including
spare parts, service contracts, and minor works
g. recurrent funds to cover equipment operational costs, including
consumable items and worn out accessories
h. recurrent funds to cover equipment-related administration, including
energy requirements
i. recurrent funds to cover ongoing training requirements.
HTM Working Groups Start using these budget lines to analyze how money is allocated and
spent for equipment purposes.
Health service providers Ensure that budgets are presented by cost centre so that it is clear what
allocations are made between central, region/district, and facility level. In
this way, you can see what money is spent on equipment activities at each
level of the health service.
Lobby other bodies involved (such as Ministry of Finance, Works) to also
show equipment expenditures by cost centre, so that you can see what is
allocated by other agencies for equipment activities in the health service.
3.4 USAGE RATES FOR EQUIPMENT-RELATED

CONSUMABLE ITEMS
If equipment is to keep functioning, you must ensure that reasonable stocks of
consumable items are held at all times, and that these form part of recurrent
budgets. You therefore need to calculate the Usage Rates for Equipment-related
Consumable Items. By doing this, you can base your recurrent budgets on the
actual ‘lifetime costs’ (daily operational, maintenance and administrative
requirements) of the items in your Equipment Inventory.
Recurrent budgets covering equipment-related consumable items are required to ensure

that equipment continues to function. Equipment-related consumable items are:
◆ equipment consumables (for example, electrodes, gels, paper)
◆ replacement accessories (for example, handpieces, probes, lenses)

◆ spare parts (for example, filters, o-rings, bearings)
61
3.4 Usage rates for equipment-related consumable items
◆ maintenance materials (for example, lengths of pipe, paint, paper for the
record system)
◆ equipment cleaning materials (for example, cotton wool, detergents, disinfectants)
◆ safety materials (for example, protective clothing, refilling fire extinguishers,
calibrating test instruments)
◆ energy supplies (for example, fuel, oil, gas, electricity).
If recurrent budgets for equipment are too small, it will not be possible to use or
maintain many pieces of equipment because you will have run out of the necessary
consumable items.
It may be the case that, in the past, equipment-related consumable items have not
been ‘stockable’ items in the Stores system, in other words items which, when stocks
run low, are automatically replenished and therefore always ‘in stock’. (Details of
how to implement such a system are contained in Guides 4 and 5).
If this is the case, you are unlikely to have sufficient information available on which
to base estimates concerning requirements and rates of use of equipment-related
consumable items. To rectify this, you need to carry out assessments of their
requirements and rates of use. Based on these assessments, you can then estimate
adequate recurrent budgets for the operation and maintenance of equipment, and
calculate correct stock reordering times. This information is useful for:
◆ improving budget allocations
◆ planning the correct timing for the procurement of supplies

◆ providing feedback on the choice of equipment.
Who is Responsible for Determining Usage Rates?

The HTM Working Group, Is responsible for establishing usage rates
or a smaller stock sub-group
(Section 1.2)
Facility level Make these calculations, use the information for
planning and budgeting purposes, and share it with
higher administrative bodies within the health service.
District/regional and central Use the information to ensure more appropriate
health authorities budget allocations are provided to the facilities.
62
3.4 Usage rates for equipment-related consumable items
How to Discover your Usage Rates

An initial exercise will be required to establish the usage rates and requirements of
equipment-related consumable items, as described in Figure 10.
Figure 10: Exercise to Establish your Usage Rates and Requirements for Equipment-related
Consumable Items
Process Activity
The HTM Working Group (or its stock sub-group) at facility level:
Investigate the actual annual requirements and rates of use

across the facility for:
Undertakes an initial one-off
• replacement accessories
exercise to establish usage rates
• equipment consumables
and requirements for
• spare parts
equipment-related consumable
• maintenance materials
items
• energy supplies
• equipment cleaning materials.
Identifies:
• the actual requirements (i.e. the
types of items, makes, sources, By:
and descriptive/identifying part • consulting with departments
numbers) • talking to equipment operators and maintainers
• the rates of use for these • referring to departmental statistics and records on patient
recurrent items by department attendance
(e.g. quantities needed per day, • referring to Stores records
week, or month in order to • using information from suppliers.
deliver the required health
service to the patients expected).
To:
Makes use of the information • calculate more realistic annual recurrent funding requirements
gathered for planning and to cover consumable items
budgeting purposes. • supply the Health Management Team with sufficient
information to set more realistic budgets.
Supply the Stores Controller with sufficient data to:

Provides feedback to the Stores • enter onto the Stores' Stock Cards (Bin Cards)
Controller • calculate correct re-ordering quantities and times
• make equipment-related consumable items ‘stockable’ items
(see Guides 4 and 5).
Provides feedback to the

Provide them with information for more appropriate selection of
Specification Writing Group and
models during procurement (see Guide 3).
the Tender Committee
Undertake an annual review as part of your equipment

Updates the information regularly. management activities (Section 8.2)
Once you have undertaken the one-off exercises to establish the planning tools, as
described in this Section, you can use them to make your long-term plans (Section 7)
and to undertake annual planning (Section 8.1). You will also need to update the
tools. This is described in Section 8.2.
63
Section 3 summary
BOX 11: Summary of Procedures in Section 3 on Discovering your Starting Point
HTM Service ◆ designs the inventory system, and the code-numbering system
Inventory
(at central level) ◆ computerizes it
Facility and ◆ gather inventory data, keep it, update it, and pass it onto the centre
District/ ◆ use the inventory code-numbering system
Regional
HTM Teams
HTM Working ◆ develop a Reference Equipment Price List, and calculate the equipment stock values
S t o c k Va l u e s
Groups ◆ revise the prices regularly in order to ensure that an up-to-date database of current
(or pricing equipment prices is available
sub-group)
◆ revise the stock values periodically
Health ◆ use the information for planning and budgeting purposes

Management
Teams
Finance Officers ◆ establish a variety of different budget elements (see Box 10), so that it is possible
(at each level to see how money is allocated and spent for equipment purposes
Budget Lines
of your
organization)
Health Service ◆ ensures that health allocations are presented for central, region/district, and facility
Provider levels, clearly showing what is spent on equipment activities
◆ lobbies other bodies involved (such as Ministry of Finance, Works) to clearly show
what is allocated for equipment activities in the health service
HTM Working ◆ undertake an exercise to discover more realistic usage rates and requirements for all
Usage Rates
Groups equipment-related consumable items (see Figure 10)

(or stock
sub-group)
Health ◆ use the information for planning and budgeting purposes

Management
Teams
64
4. How to discover where you are headed – planning tools II
4. HOW TO DISCOVER WHERE YOU ARE

HEADED – PLANNING TOOLS II

To manage your healthcare technology effectively, you need to have a clear
idea of your goals and targets, and the context in which you are operating.
It is very difficult to manage without knowing what you are trying to achieve.
Equipment, for example, should not be viewed in isolation – it is there for a
purpose, and must be managed according to set objectives.
To plan effectively, you require access to a wide range of information and
reference materials. You also need a clear vision of the direction your health
service is going in, plus a definition of what equipment is required to help you
achieve the health service goals.
To ensure any equipment purchasing is planned and rational, you will need to
have good policies and procedures in place. These will provide guidance on
the valid reasons for buying equipment, as well helping you to decide what
equipment to buy.
It is better to plan and budget with specific goals in mind. You therefore need to
gather information which will help you to understand the goals and objectives for
your equipment.
To help you analyze your future equipment needs, you need some further ‘planning
tools’. This Section covers five additional tools, and discusses how to discover the
direction you are going in, by:
◆ having access to information and reference materials (Section 4.1)
◆ developing a Vision for health service delivery (Section 4.2)

◆ translating that Vision into Model Equipment Lists (Section 4.3)
◆ agreeing what your equipment purchasing, donations, replacement, and disposal
policies are going to be (Section 4.4)
◆ writing Generic Equipment Specifications (Section 4.5).
Different health service providers will have reached different stages in deciding on
the direction to go in, depending on the amount of planning they have already
carried out. The direction you take will depend on:
◆ your country

65
4. How to discover where you are headed – planning tools II
This Section describes how to undertake one-off exercises to establish these tools.
Different activities are described for the different health service levels. This work
will help you to discover where you are headed.
The use of these tools in the planning and budgeting process is provided in Section 7,
and Section 8 discusses how to monitor and update the tools.
4.1 REFERENCE MATERIALS

To increase their skills in planning and budgeting for the equipment stock, health
service providers need to expand their information and knowledge base concerning
equipment and its management. Therefore it is useful to develop a library of
equipment literature, covering a broad range of types of documents. These are
known collectively as reference materials, and provide background advice for
equipment planning and budgeting.
To keep up-to-date, it may be useful to subscribe to regular equipment information

sources, such as hazard reports and monthly journals. Due to the cost, you may need
to ask for assistance from external support agencies. Information regarding the
sources of some useful literature is given in Annex 2.
It is advisable for some data to be kept in every health facility and maintenance
workshop, so that staff can be encouraged to read and learn from reference material
which is available close at hand.
Who is Responsible for Gathering Reference Material?

Preference
For information to be available at all levels of the health service.

Health Management Teams Organize the gathering of reference material
The Central Health Is in a much better position to finance subscriptions,
Management Team to ask for assistance from external support agencies,
and to share information around all levels of the
health service.
Health Management Teams Should pursue strategies to gain more information,
at individual facilities and and develop their own equipment libraries.
districts
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4.1 Reference materials
How to Obtain Reference Materials

There are several ways of obtaining reference materials. Box 12 provides a variety of
strategies for trying to get hold of different types of data and expand your library.
Some data which costs a lot of money to obtain may only be collected by the central-
level HTM Team, and they should pursue the strategies listed for sharing this
information around the HTM Service network.
BOX 12: Strategies For Sourcing Useful Literature and Advice (see Annex 2),
and Expanding your Library
Strategy Type of Material/Information Action

Obtain literature which is ◆ manufacturers’ brochures For existing equipment, find as many
usually available free of (from manufacturers and their of these as possible.
charge. representatives)
◆ procurement catalogues from
bulk suppliers
◆ lists of the manufacturers
registered nationally with the
central Ministry of Health.
Obtain literature from ◆ Model Equipment Lists Contact as many other health
neighbours which, with ◆ equipment specifications facilities and health service provider
negotiation, may be organizations in your country and
◆ copies of manufacturers’
available for the cost of neighbouring countries as possible,
operator and service manuals
photocopying and postage. to obtain existing resources.
for older machines
◆ lists of registered
manufacturers.
Obtain information ◆ text books on a variety of Try to get hold of these resources,
available internationally subjects (including advice on perhaps subscribe to them, and look
which can be paid for as planning and budgeting) for help to pay for them.
one-off items, or by annual ◆ manufacturers’ operator and
subscription (depending service manuals
on the material type and
◆ Equipment Evaluation Reports
source). This material may
and Product Comparison data
come as a hard copy or as
◆ technology assessment
part of a software package.
literature
◆ Equipment Hazard Reports
and safety literature
◆ journals
◆ internationally available advice
on equipment issues.
Continued overleaf
67
4.1 Reference materials
BOX 12: Strategies For Sourcing Useful Literature and Advice (see Annex 2), and Expanding
your Library (continued)
Strategy Type of Material/Information Action

Make sure you order ◆ operator manual ◆ when the manuals arrive, store the
relevant literature when ◆ service manual. original copies in a safe place (such
purchasing all your new as the HTMS library, the facility
equipment (see Guide 3). library, the workshop library)
◆ make photocopies of the operator
manuals, and give one copy to the
relevant user department, and
one copy to the HTM Team or
relevant workshop
◆ make photocopies of the service
manuals, and give one copy to the
HTM Team or relevant workshop.
Investigate other sources ◆ suppliers Make use of internet (world wide

for getting literature/ ◆ manufacturers’ local web) contacts where possible, as this
information which you do representatives method will become more and more
not have. important in future.
◆ international agencies
◆ links with health facilities
abroad.
If material is no longer ◆ CD-Rom Investigate these alternative sources

available on paper, find a ◆ video of information. Make copies and
more accessible format. print-outs of the material and make
◆ DVD.
it available to other facilities.
Scan single copies of ◆ user manuals Scan these documents into your
printed documents into a ◆ service manuals computer system and make them
computer and keep them more easily available to maintenance
as electronic copies. technicians at many locations.
4.2 DEVELOPING THE VISION OF SERVICE

DELIVERY FOR EACH FACILITY TYPE
As Section 2.1 explains, the Vision for your health facility tells you the direction of
healthcare delivery (in terms of the interventions and procedures to be carried out).
By referring to the Vision, you can determine what type of equipment you require.
When developing the Vision for a certain level of health facility, it is very important
to be reasonable and realistic in your goals. As Section 2.2 explains, you need to be
aware of the cost implications associated with any of your proposed goals (such as
developing Essential Service Packages).
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4.2 Developing the vision of service delivery for each facility type
For example, you might decide that decentralizing your services provides a fairer
level of access for the surrounding population. However, great care must be taken to
ensure that any such move is affordable. If not, you run the risk of putting funding
for existing services in danger.
Experience in South Asia

The Ministry of Health in a Southern Asian country felt pressured by manufacturers,
professional staff, and the example set by private health service providers to develop
public services in a certain direction. Such a development was dependent on the
purchase of sophisticated technologies, such as CT scanners, MRI scanners, cardiac-
angiography machines and video endoscopes.
However, in a recent survey they discovered that the utilization of these items is less
than 10 per cent due to the lack of available manpower and recurrent budgets. This
shows how important it is not to allow realistic decision-making to be undermined by
outside pressures.
Who is Responsible for Developing the Vision?

The body or organization responsible for developing the Vision will vary from country
to country. This will depend upon:

Preference
It is unhelpful to have lots of individual facilities pulling in different directions, and no
coordinated plan for the health service as a whole. It is easiest for all concerned if your health
service provider at central level considers what sort of healthcare will be provided at each
level of your health service. They should collaborate with the Ministry of Health and follow
MOH guidance.
Tip • Your health service provider at central level might not be undertaking a Vision
exercise. Do not let this prevent you from working on the Vision for your health
facility, as long as you stay within sensible goals for your level of the health service.
69

Health Management Teams Organize special meetings of different types of staff
at each level at each level to discuss the Vision.
HTM Working Group Advises the Health Management Team on all
(Section 1.1) technology issues during this process.
Central Level Takes the first step and develops the overall Vision
for the direction of the health service as a whole.
Regional/District Level Once this Vision has been completed or updated,
takes the second step and defines the services to
be provided by individual health facilities. By:
- studying the map of facilities for their area
- considering how their region/district varies from
the norm described by the centre.
Facility Level Once the services have been defined for the district,
takes the third step and looks at the possibilities
they have for providing the defined services.
How to Develop your Vision

The Health Management Team at each level should organize a series of meetings to
discuss the development of the Vision. These meetings should include a cross-
section of different types of staff from their level (facility, district/region, or service
as a whole). As well as involving staff, it is also important to ask questions of your
customers (as far as is possible), especially when they contribute to covering the cost
of the health service provided.
At these meetings you should discuss:

◆ the direction that the service should be taking
◆ the sort of care that should be provided now and in the future
◆ the sort of interventions and procedures that will be carried out; and
◆ the type of healthcare technology required.
These meetings should take into account:

◆ healthcare trends
◆ demographic data
◆ epidemiological profiles
◆ priority health problems
◆ the clinical and referral features of the target area
◆ the infrastructure, finances, and human resources available
◆ local strengths and weaknesses
◆ the support available from external support agencies.
70
To inform the technology part of the debate, the HTM Working Group (at each
level) should consider the equipment implications of the healthcare interventions
suggested, and then offer technical advice to their Health Management Team.
Box 13 shows some of the issues that the Central Level HTM Working Group
should consider.
BOX 13: Equipment Considerations for the Vision at Central Level
Issues Examples
What expansion of services ◆ What should be the role of a hospital (central, referral, district, or rural), in
is necessary or feasible? terms of the interventions and procedures to be carried out? What does
this mean in terms of equipment availability?
◆ What type of care can be offered by rural, district or town health centres?
Can any types of care be transferred over to them? What does this mean in
terms of equipment availability?
◆ It may be best to locate certain specialized services (such as intensive care
units) only at certain hospitals. Some specialized services, such as
radiotherapy, may only ever be offered at national/central level. With
pressures to reduce costs, improve efficiencies, and possibly to reduce
staff numbers, can service provision be rationalized? Is expansion based
only on needs that can be realistically met?
What are the implications ◆ Introducing a new service has knock-on implications for human, material,
in terms of staff, skills, and financial resources. Why buy eye instruments for a facility if there is
resources, patient referral no eye surgeon, or prospects of one becoming available?
networks? ◆ If the referral system is such that dialysis is only undertaken and
supported at a central facility, think carefully before placing dialysis
machines at, for example, 10 further locations. Such a move would have
major and costly knock-on effects. For example, at each of the 10 locations
you would need to:
- recruit or train renal doctors and surgeons
- finance and supply dialysis machines, water treatment systems,
specialized laboratory services and equipment
- provide renal nurses and after care services
- provide regular supplies of consumables and maintenance support, as
well as recurrent budgets.
Are desired expansions ◆ Although many hospitals may ideally wish to have fluoroscopy facilities
financially affordable? (for example), at a cost of approximately $500,000 per suite is this a
feature each hospital can necessarily invest in?
Do the services suggested ◆ Is it possible to develop a Vision which fits in with the other health service
fit into the overall Health provider organizations?
Service in the country?
71
Box 14 shows some of the issues that the Regional/District Level HTM Working
Group should consider.
BOX 14: Equipment Considerations for the Vision at Regional/District/Diocesan Level
Issues Examples
Are some services ◆ Each facility may wish to offer all services, but this may not be practicable.
duplicated in facilities In many cases, it may be necessary and important to share service
near to each other and provision. Which healthcare interventions can be shared with other types
therefore over-provided? of facility in the neighbouring area (such as the referral hospital, the town
clinic, rural outreach services)? Can you reduce your equipment
requirements by sharing services?
◆ Are there neighbouring facilities or health services (such as a flying doctor
service) which are better able to offer certain interventions – for example
services for Ear Nose and Throat, eye specialists, sophisticated imaging? If
they are better equipped to provide such services, you might agree that
they will be the source of those services and limit your equipment
requirements in those areas.
Are there alternative ways ◆ Are there other providers who could supply you with services you require,
to provide healthcare such as hot meals, clean linen, incineration? If so, would the reduction in
interventions? equipment capital and recurrent costs outweigh the cost of buying in
those services?
Do the services ◆ Is it possible to develop a Vision which fits in with the neighbouring
suggested fit into the regions/districts and other health service provider organizations?
overall health service in
the surrounding area?
72
Box 15 shows some of the issues that Facility Level HTM Working Groups should
consider.
BOX 15: Equipment Considerations for the Vision at Facility Level
Issues Examples
Are some services ◆ Perhaps your facility was built with three operating theatres, but are they
duplicated within all in use all of the time? Can the use of the theatres be rationalized and
the facility itself? operating times maximized, so that new theatre equipment does not need
to be purchased three times (in this example) for many separate theatres?
◆ Some countries have introduced fee-paying systems. This can result in a
difference between fee-paying (high cost) and non-fee-paying (low cost)
services, causing duplication of services. Can the difference between high
and low cost be based on factors such as more prompt service, more
experienced staff, better food? In this way, can you avoid two physically
separate sets of facilities which lead to duplication of expensive equipment,
especially in areas such as intensive care, labour, or dental units?
Are there alternative ◆ Does your geographical area lend itself to different ways of providing
technology strategies services which may be more cost-effective or reliable? For example, can you
for providing the use solar energy for your electricity, a biogas plant for your sewage system, a
services required? borehole water supply, radio communication, oxygen concentrators?
Do the services suggested ◆ Is it possible to develop a Vision which fits in with the neighbouring
fit into the overall facilities and other health service provider organizations?
health service in the
surrounding area?
Following these considerations, the Health Management Teams should:

◆ develop a reasonable and realistic Vision for the health service in terms of the
procedures and interventions to carry out, and produce it as a formal document; and
◆ ensure the approved written Vision is used as the basis of subsequent equipment
planning and budgeting decisions.
4.3 MODEL LISTS OF EQUIPMENT PER

INTERVENTION
Once the Vision for the direction of health service delivery for a facility has been
developed (Section 4.2), you will know the healthcare interventions and procedures
you will be offering. Based on this information, you can then develop Essential
Service Packages, which should translate the Vision into:
◆ human resource requirements, and training needs
◆ space requirements, and facility and service installation needs

◆ equipment requirements.
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4.3 Model lists of equipment per intervention
This Section concentrates upon equipment requirements, and considers the process
of defining what equipment is needed for each healthcare intervention. The
planning ‘tool’ used to do this is the Model Equipment List.
What is a Model Equipment List?

A Model Equipment List is:
◆ a list of equipment typically required for each healthcare intervention (such as a
healthcare function, activity, or procedure). For example, health service providers

might list all equipment required for eye-testing, delivering twins, undertaking
fluoroscopic examinations, or for testing blood for malaria
◆ organized by activity space or room (such as reception area or treatment room),
and by department
◆ developed for every different level of healthcare delivery (such as district,
regional and central), since the equipment needs will differ depending on the
Vision for each level
◆ usually made up of everything including furniture, fittings and fixtures, in order
to be useful for planners, architects, engineers and purchasers
◆ a tool which allows you to see if your Vision is economically viable.
The Model Equipment List must reflect the level of technology of the equipment.
It should describe only technology that the facility can sustain (in other words,
equipment which can be operated and maintained by existing staff, and for which
there are adequate resources for its use). For example a department could have:
◆ an electric suction pump or a foot-operated one
◆ a hydraulic operating table or an electrically controlled one

◆ a computerized laundry system or electro-mechanical machines
◆ disposable syringes or re-usable/sterilizable ones.
As Section 2.2 explains, it is important that any equipment suggested:

◆ can fit into the rooms and space available. You should therefore refer to any
building norms which define room sizes, flow patterns, and requirements for
water, electricity, light levels and so on
◆ has the necessary utilities and associated plant (such as the power, water, waste
management systems) available for it on each site. If such utilities are not
available, it is pointless planning to invest in equipment which requires these
utilities in order to work
◆ can be operated and maintained by existing staff and skill-levels, or for which the
necessary training is available and affordable.
Due to these factors, Model Equipment Lists will vary from country to country.
74
Usefulness of the Model Equipment Lists

A Model Equipment List is an aid to the planning process. In order to plan what
equipment to purchase, you will need to be aware of any shortfall in equipment. To
determine such shortfalls, you will need to compare your Equipment Inventory
(Section 3.1) with your Model Equipment List. This will enable you to determine
whether any equipment is currently missing or needs to be purchased.
Thus, the Model Equipment List will help you determine what equipment is:
◆ necessary
◆ surplus
◆ extravagant
◆ missing
in relation to the Vision for your facility.
Who is Responsible for Developing Model Equipment Lists?

Who has responsibility for developing the Model Equipment Lists will vary from
country to country. It will depend on:

Although at district or hospital level there may be sufficient medics, often there are
limited economists and technical personnel with management skills for the facilities
and districts to complete the task of developing Model Equipment Lists alone
(Section 2.2). It is very important that this task is undertaken by a multi-
disciplinary team, so that decisions benefit from the skills and views of all
disciplines, not just one or two.
75
Preference
Your health service provider at central level should consider developing Model Equipment
Lists in collaboration with staff from each level of the service. It is not helpful to have lots of
individual facilities pulling in different directions, with no coordinated plan for the health
service as a whole.

HTM Working Group Organizes special meetings of different types of staff
at each level to work on the Model Equipment List. Then reports
back to the Health Management Team.
Central Level Takes the first step and runs specific exercises to
establish the Model Lists of Equipment for each
clinical and support area, at each operational level.
Regional/District Level Takes the second step and adjusts the list on a
regional/district basis to cover local variations.
Facility Level Takes the third step and assesses:
- how they can provide the healthcare interventions
- what numbers of equipment they require
depending on how they organize their work.
Organizational decisions influence the quantity of
equipment. For example, the timing of clinics can
reduce or increase the workload in the laboratory.
Before ordering new equipment, you will need to
assess its level of use. (For example, as a microscope
is used for a number of tests, the work pressure
upon it must first be established, before deciding
whether there is a need for additional microscopes).
Tip • Your health service provider at Central level might not be undertaking an equipment
list development exercise. Do not let this prevent you from working on the Model
Equipment List for your health facility, as long as you stay within sensible goals for
your level of the health service.
How to Create Model Equipment Lists

When each level works on the Model Equipment List, the HTM Working Group
should organize a consultation exercise for staff. The best way to do this is by
arranging a series of meetings. A cross-section of different types of staff should be
brought together, from across all the various levels the HTM Working Group is
responsible for (such as facility, district/region, or service as a whole). In these
meetings, each discipline needs to decide the types of equipment required to
provide the healthcare interventions described in the written Vision (Section 4.2).
76
During these meetings, it is important not to simply look at the space available and
draw up a list of equipment to fill it. The idea is to consider:
◆ the disease burden that the facility faces
◆ the healthcare interventions that are required at that level of facility

◆ the equipment needed to provide those interventions and the technology level
that can be sustained
◆ the quantities of each type of equipment required. Factors to consider include:
- which interventions can share equipment (for instance, could several surgical
procedures share an operating table?)
- whether the location of activities requires duplication of equipment (for example,
the number of resuscitations per year may only call for one resuscitation bag, but
clinically it is safer to have a resuscitation bag available at several locations).
Tip • To begin with, the task of creating Model Equipment Lists may appear to be
overwhelming. A simple way to start might be to take a critical look through the
equipment lists of neighbouring countries. Disease patterns do not fluctuate that
much between neighbouring developing countries, and financial and technological
capacity are likely to be largely similar. (Further information on Model Equipment
Lists developed by a variety of agencies and countries is given in Annex 2). You
could simply adapt existing Model Equipment Lists for your own situation, if you do
not have the resources or central support for a full exercise
For HTM Working Groups at Regional/ District and Facility Level where there may
be limited management skills (Section 2.2), making comparisons with other
countries’ Model Equipment Lists may be the most effective way of working.
At Central level you may require some computer software to assist you when
undertaking the clinical, technical, and economic analysis. This would also be
beneficial if the centre is responsible for compiling and overseeing lists for the rest of
the health service. Annex 2 provides further information on how to computerize
your Model Equipment Lists, together with some equipment analysis software
products that are available.
Tip • The WHO recommends the use of the ‘Essential Healthcare Technology Package’
(EHTP) approach for determining equipment lists. Annex 2 provides details of
EHTP software which would usually be applied at central level.
77
Box 16 describes an exercise for consulting staff that can be undertaken to develop Model
Equipment Lists.
BOX 16: Exercise to Develop your Model Equipment Lists
People and Steps Example Activities

The HTM Working Group ◆ uses the Equipment Inventory as a starting point, in order to develop a list
gathers useful reference for each department
materials from various ◆ draws upon any existing Equipment Development Plan for the facility
sources which can stimulate (Section 7.1)
discussions, and can be
◆ uses Model Equipment Lists from neighbouring countries as a reference
modified according to
point, which can be modified to suit the health service’s own working
local needs.
practices (see Annex 2)
◆ seeks guidance from the central health service provider organization on
the Vision for the health service
◆ refers to any international guidance available
◆ uses any computer software programs available (if you have access to
them).
The HTM Working Group ◆ surgeons, theatre nurses, CSSD staff, and medical equipment technicians
sets up a series of small to discuss equipment required for theatre interventions
working groups of different ◆ different grades of laboratory staff, maintenance staff and doctors to
types of staff for different discuss the needs for laboratory services
working areas, until all ◆ doctors, physiotherapy staff, maintenance personnel to discuss
departments have physiotherapy needs
been covered.
◆ the Support Services Manager, a range of kitchen staff, ward managers,
maintenance staff, and employee representatives to discuss kitchen and
canteen requirements,
and so on.
Each working group ◆ considers the reference materials obtained

undertakes a series of tasks ◆ discusses what equipment is required for each of the healthcare
so that they can develop an interventions offered in the written Vision for the facility/service level, for
Equipment List for their their department or area
working area. ◆ provides a realistic estimate of the type of equipment required to provide
the service to be offered, being careful not to create a wishlist which can
never be attained
◆ provides a realistic estimate of the level of technology which can be
sustained
◆ determines the numbers of each item required for the existing patient
throughput, staffing levels, and work organization
◆ considers all the items required to work effectively, including –
equipment, furniture, hardware (clocks, waste bins, kidney bowls),
instruments and utensils
◆ creates a departmental list of all items and their quantities, on an ‘activity
by activity’ and ‘room by room’ basis.
Continued opposite
78
4.4 Purchasing, donations, replacement, and disposal policies
BOX 16: Exercise to Develop your Model Equipment Lists (continued)
People and Steps Example Activities

The HTM Working Group ◆ compiles the clinical/support area lists
prepares and reviews ◆ determines quantities, by identifying where several interventions can
the final list. share an item of equipment, and highlights areas where the location of
activities means that duplication of equipment is necessary
◆ finalizes the Model Equipment List for that facility
◆ develops a mechanism for updating the lists over time.
The Health Management ◆ approves the Model Equipment List

Team gives overall approval ◆ ensures it is used as the basis of equipment planning and budgeting
for the proposals. decisions.
4.4 PURCHASING, DONATIONS, REPLACEMENT,

AND DISPOSAL POLICIES
4.4.1 General Issues
Having gone through a detailed planning and budgeting process, you will then be in a
position to acquire equipment, either through procurement or donations. In order to
ensure you obtain only what you need, you must undertake an acquisition process
which is both rational and planned.
Any new or additional equipment must be acquired according to good policies and
procedures. When planning, you should consider both the costs of replacement and
disposal of existing equipment, and also the costs of purchase and donation of
additional items. A useful planning tool is the Purchasing, Donations,
Replacement, and Disposal Policies. These are a series of policies which guide
you on the process of decision-making for new acquisitions and help you to
determine what equipment you should obtain.
Ideally the Ministry of Health will have developed a Healthcare Technology Policy
which other health service providers can use as guidance, or follow if regulated to do
so (Section 2). Central authorities of all health service providers should be actively
involved in expanding these details and developing policies of their own, which cover
all aspects of the life of equipment. The Purchasing, Donations, Replacement, and
Disposal Policies will thus form one part of a wider Healthcare Technology Policy.
Alongside the policies for internal use, health service providers also need to develop
donor regulations (see Guides 1 and 3) to ensure that all equipment received
through foreign aid and donations complies with existing standards and policies.
Guidance on developing and implementing such regulations is provided in Annex 2.
79
4.4.1 General issues
Who is Responsible for Developing Purchasing/Replacement Policies?

Health Management Approve the equipment policies
Teams, with advice from
their HTM Service on
technical issues.
The central HTM Service Should develop Purchasing, Donations,
Replacement, and Disposal Policies for equipment,
and share them with each facility and district/region.
Any health service level Can develop and implement policies.
(central, region/district,
facility) with the help of
their HTM Service
Tip • Your health service provider may not have developed such policies. Do not let this
prevent you from doing so for your health facility.
4.4.2 Purchasing and Donations Policies

To make the best use of your finances, you should only acquire equipment according
to rational, reasonable arguments and not according to random or wild demands.
Therefore it is useful to develop policy statements for purchasing and donations of
equipment. These will fall into two parts:
i. when to purchase
ii. what to purchase.
When to Purchase
Each facility should acquire equipment for valid reasons only and according to an
order of priority, both of which should be defined. Box 17 provides an example of
suggested valid reasons and an order of priority.
If there is a shortage of funds, acquisition should then take place in the same order of
priority as shown in Box 17. This will:
◆ protect acquisitions which cover equipment as it fails at the end of its life; and
◆ ensure that, as a bare minimum, the existing status quo is maintained.
Otherwise, the existing health service provided will start to deteriorate.
80
4.4.2 Purchasing and donations policies
BOX 17: Example of Valid Reasons and Order of Priority for Purchasing and Donations of
Equipment
There are four reasons for procuring/donating equipment, each of which provides a different goal which will
dictate when to acquire equipment. These can be placed in the following order of priority:
1. To cover depreciation of equipment. Equipment is replaced as it reaches the end of its life and is taken
out of service. This is necessary in order for the level of healthcare you currently deliver to be sustained.
Note: This means that the size of your existing equipment stock remains the same, and does not imply
an expansion of the health service.
2. To obtain additional equipment items which are missing from the basic standard requirements.
Additional equipment may be required in order to provide a basic standard level of care.
Note: Missing items are identified by comparing the Equipment Inventory with the Model Equipment
List for the facility.
3. To obtain additional equipment items beyond the basic standard. This is done in order to upgrade
the level of health service provided by the hospital. For example, new equipment may be needed to
provide a new service, build a new special unit, or increase the level of care offered.
4. To obtain additional equipment items outside the facility’s own plans. This will only be applicable
if the additional items have been called for by directives from the central health service provider
organization or a national body and cannot be stopped/refused for political reasons, such as ‘out of the
ordinary’, high profile, or political projects.
Within each of the four categories shown, priorities will have to be set. The priorities can be based on
indicators which measure your progress with attaining the goals. These are discussed in Section 7.1 on
Equipment Development Planning.
Experience in South Asia

The public health sector of a Southern Asian country does not have a Healthcare
Technology Policy or standards. It finds it difficult to control the purchase of equipment.
Ministry of Health officials face the following problems:
◆ Requests from influential clinicians or politicians to buy inappropriate equipment,
which need to be challenged.
◆ When funds are refused for such items, use of the mass media to override the official
decision and appeal to the public for donations.
◆ The high turnover rate of the Minister and Permanent Secretary of Health means the
new incumbents continually want to make gestures for their electorate of new and
sophisticated equipment projects.
◆ Often, the MOH may be forced to succumb to such public and political pressures and
fund such projects.
Equipment acquisition should only occur under the umbrella of an Equipment

Development Planning Process, so that it is rational and planned (Section 7.1).
Any acquisition should also be guided by the priorities laid out in any annual
development plans (Section 8.1).
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What to Purchase
To help you to obtain only equipment which is appropriate to your needs, your
purchasing and donations policies should clearly specify the ‘good selection criteria’
to employ. All equipment should:
◆ be appropriate to your setting
◆ be of assured quality and safety

◆ be affordable and cost-effective
◆ be easily used and maintained
◆ conform to your existing policies, plans, and guidelines.
Tip • Only select equipment that is suited to your needs. For example:
There is little point in acquiring an expensive piece of equipment which:
- has capabilities that are hardly ever utilized
- is almost impossible to keep in running order
- is difficult to operate safely and effectively.
There is little point in acquiring a cheap or poor-quality piece of equipment which:

- does not have the capabilities that your staff require
- falls apart easily and must be replaced quickly
- is of poor design and cannot be operated safely.
The selection process is described in full in Guide 3 on procurement and

commissioning.
Box 18 summarizes good selection criteria.
BOX 18: Example of Good Selection Criteria for Purchasing and Donations of Equipment
Indicators of appropriateness Criteria
Appropriate to setting Equipment should be:

◆ suitable for the level of facility and service provided
◆ acceptable to staff and patients

◆ suitable for operator skills available
◆ suitable for the local maintenance support capabilities
◆ compatible with existing equipment and consumable supplies
◆ compatible with existing utilities and energy supplies
◆ suited to the local climate, geography and conditions
◆ able to be run economically with local resources.
Continued opposite
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(continued)

Assured quality and safety Equipment should be:
◆ of sufficient quality to meet your requirements and last a
reasonable length of time

◆ made of materials that are durable and hard-wearing (for example,
aluminium bends easily compared to iron or stainless steel)
◆ made from material that can be easily cleaned, disinfected, or
sterilized without rusting (for example, a polymerized finish or an
epoxy coating)
◆ made of materials that do not easily break (for example,
polycarbonate rather than glass)
◆ manufactured to meet internationally recognized safety and
performance standards (see Guides 1 and 3)
◆ suitably packaged and labelled so that it is not damaged in transit
or during storage
◆ provided by reputable, reliable, licensed manufacturers, or
registered suppliers.
Affordable and cost-effective Equipment should be:

◆ available at a price that is cost-effective. Quality and cost often go
together (for example, the cheaper option may be of poor quality

and ultimately prove to be a false economy)
◆ affordable in terms of costs for freight, insurance, import tax, etc.
◆ affordable in terms of installation, commissioning, and training of
staff to use and maintain them
◆ affordable to run (for example, cover the costs of consumables,
accessories, spare parts and fuel over its life-time)
◆ affordable to maintain and service
◆ affordable to dispose of safely
◆ affordable in terms of the procurement process (for example the
cost of a procurement agent or foreign exchange)
◆ affordable in terms of staffing costs (for example, costs of any
additional staff or specialization training required).
Continued overleaf
83
(continued)

Ease of use and maintenance You should choose equipment:
◆ for which you have the necessary skills in terms of operating,
cleaning, and maintenance
◆ for which instructions and manuals are available to you in a
suitable language
◆ for which staff training is offered by the supplier
◆ for which local after-sales support is available with real technical
skills
◆ which offers the possibility of additional technical assistance
through service contracts
◆ which comes with a warranty/guarantee, covering a reasonable
length of time, for which you understand the terms. (For example,
does it cover parts, labour, travel, refunds or replacements?)
◆ which offers a supply route for equipment-related supplies (for
example, consumables, accessories, spare parts)
◆ which offers assured availability of these supplies for a reasonable
period (up to 10 years).
Conforms to existing policies, plans You should choose equipment:

and guidelines ◆ according to your purchasing and donations policy
◆ according to your standardization policy
◆ according to the technology level described in the Model
Equipment Lists and Generic Equipment Specifications
(Sections 4.3 and 4.5)
◆ which is deemed to be suitable, having studied available literature
and compared products (see Box 12 and Annex 2)
◆ which is deemed to be suitable, having received feedback
regarding previous purchases (Section 8.2).
If the equipment fails to meet these ‘good selection criteria’ (Box 18), you will have
to find ways around all the drawbacks that will arise. Alternatively, you could decide
not to acquire equipment which does not meet the selection criteria, and choose
another type, make, or model.
Introducing an element of standardization in the equipment purchased will help you

to limit the wide range of makes and models of equipment found in your stock
(Section 2.1). By introducing standardization, your technical, procedural and
training skills will increase, and your costs and logistical requirements will decrease
(see Guide 1). If procurement is carried out on an individual facility basis, you will
almost certainly be left with items of equipment which are uneconomic to maintain.
For this reason, it is extremely important to try to collaborate and procure
equipment at a central or regional level (Section 2.2).
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4.4.3 Replacement and disposal policies
Tip • When you, or an external support agency, acquire equipment, it is important to

conform to any standardization policies or strategies that your health service
provider has introduced.
Equipment purchases and donations should be costed according to the principles

provided in Section 5.2 of this Guide, in order to determine which items can be
afforded over their life-cycles.
4.4.3 Replacement and Disposal Policies

The majority of equipment acquisitions should be carried out for the purpose of
replacing existing stocks as they reach the end of their lives (see the order of priority
for purchasing and donations in Box 17).
Replacement is necessary because all equipment has a finite life expectancy. This
lifespan will depend upon the type of equipment, and the types of technology
contained within it. For example, five years might be the typical life for an ECG
monitor, 10 years for a suction pump, 15 years for an operating table, and 20 years for
an electricity generator. Once the equipment reaches the end of its life no amount of
intervention (such as maintenance) will be effective, and the only option will be to
replace it. International guidance on equipment lifetimes is available in Annex 3.
If replacement of equipment is not planned for, the health service delivered to the
public will simply deteriorate. If you do not replace equipment at the end of its life,
there will be:
◆ an uneven standard of reliability among your equipment
◆ a general deterioration in:

- performance
- safety
- dependability
- availability for use.
Each facility should replace equipment for valid reasons only, which should be
defined. Box 19 provides an example of suggested valid reasons, and criteria for
condemning equipment.
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BOX 19: Example of Valid Reasons for Condemning and Replacing Equipment
Valid Replacement Criteria

i. Equipment will only be replaced when one of the following valid reasons has been fulfilled:
a. it is worn out beyond repair (has reached the end of its natural life)
b. it is damaged beyond repair
c. it is unreliable – faulty, old, unsafe
d. it is clinically or technically obsolete
e. spare parts are no longer available
f. it is no longer economical to repair.
and one of the following valid reasons has also been fulfilled:
g. utilization statistics are available to show that it is still required
h. a demonstrated clinical or operational need still exists.
ii. Equipment will not be replaced simply because:

◆ it is old
◆ staff do not like it
◆ a newer model has arrived on the market.
Judging When it is Time to Condemn Equipment

Senior maintenance staff need to study the equipment, and judge:
◆ whether the equipment fulfils any of the valid replacement criteria (see above)
◆ whether the equipment has outlived its (internationally/locally) advised typical ‘lifetime’ (see Annex 3)
◆ the equipment’s track record and state of health, as documented in its service history records (see Guide 5)
◆ whether it will be necessary to override the average expected lifespan and condemn the equipment early,
or even to extend the lifespan of the equipment.
For expensive equipment, it may be helpful to obtain an evaluation from the supplier.
Formal procedures must exist for condemning and disposal of equipment. Failure to
dispose of equipment properly could result in the following:
◆ graveyards of abandoned equipment piling up around health facilities
◆ departments, store rooms, cupboards, and workshops full of old equipment

◆ previously condemned equipment ending up back on the wards and being re-used.
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Once equipment has been condemned, you need a formal policy to oversee its
disposal. This should cover:
◆ how it should be disposed of safely
◆ how it can be disposed of as promptly as possible

◆ how it can be disposed of in an environmentally sound way according to your
‘Waste Management and Hygiene Plan’
◆ how you can strip off the useful spare parts before the equipment is disposed of.
These issues are discussed in Guide 4 on operation and safety.
The condemning and disposal of equipment should trigger the purchase of a

replacement piece of equipment. It is preferable to plan for replacements before
they are needed and, where possible, you should identify likely replacement needs
within your annual Equipment Inventory update and annual plans (Section 8.1).
These activities should be timed to take place ahead of the next procurement cycle,
which usually takes place annually (see Guide 3).
In summary, to replace and dispose of equipment it is necessary to have the following:

◆ technical skills to identify those items ready for replacement
◆ good procurement practices which enable you to finance and purchase

replacement items in good time
◆ courage and determination to take equipment out of service when necessary, even
if the users want to keep using it
◆ a formal method for condemning equipment
◆ a formal method for disposing of the equipment, safely and in an environmentally
sound way
◆ a formal method so that the disposal of equipment triggers the purchase of a
replacement item.
All these formal methods are described in Guide 4 of this Series.
4.5 GENERIC EQUIPMENT SPECIFICATIONS AND

TECHNICAL DATA
Having drawn up Model Equipment Lists (Section 4.3) and Purchase/Replacement
Policies (Section 4.4), you are ready to begin the process of acquisition. Whether you
are carrying out procurement on your own behalf, or have enlisted the help of an
external support agency to do it for you, purchase orders or requests for
tenders/quotations have to be prepared. All such purchase documents should include:
◆ Item information, describing what you want to purchase (equipment
specifications, quantities, technical and environmental data)
◆ Order information, describing the terms and conditions for supplying the goods
(qualification and evaluation criteria, delivery and payment terms, etc.)
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4.5 Generic equipment specifications and technical data
The compilation and use of such purchase documents for acquiring your equipment
is described in Guide 3 on procurement and commissioning. However, establishing
the item information is a specialist technical task and requires advanced planning.
Ideally, you should write your own equipment specifications, so that whoever is
procuring/providing the goods can conform to your requirements. Useful planning
tools to help you are Generic Equipment Specifications and Technical Data.
These should be written by in-house technical staff, so that they can be used by
procurement staff from any organization.
The specifications provide the detailed technical description of each type of

equipment on your Model Equipment List. You may require specialist help with
writing such specifications.
What are Generic Equipment Specifications?

A clear specification includes:
◆ a detailed description of the equipment
◆ the ‘package of inputs’ needed to keep the equipment going through its lifetime
(including consumables, installation, training and after-sales support)
◆ the quantities required.
The specification is the most important document for both the purchaser and for
the potential supplier, since it sets out precisely what characteristics are required of
the products or services sought. Often, this is your only chance to detail your
selection criteria (see Box 18, Section 4.4.2), including requirements for certain
levels of technology, quality, safety, appropriateness, consumable inputs, training,
and technical support. This is especially the case if you are using a tendering process
(see Guide 3), when it is not legal to introduce additional terms and conditions after
the tender bids have been received. Therefore any preferences you have in these
areas must be highlighted within the initial specification.
When drawing up a product specification, it is best to describe equipment according

to its type or class – in other words to describe its function. The advantages of this
approach are:
◆ it describes exactly what the equipment will be required
to do
Generic
means a ‘type’ of thing, ◆ it enables any supplier to offer any products which will
or a ‘class’ of item or object. perform that function
◆ it does not limit the product only to one brand name or
make of product.
Although many variations exist, unfortunately many common problems arise as a

result of poor specification-writing. Some examples of this can be seen in the
‘Country Experiences’ box opposite.
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Country Experiences
Examples of the kinds of problems which have arisen in various countries due to poor
specifications are:
Equipment that ◆ Equipment arrives without the necessary accessories
is incompletely ◆ There is a lack of consumables such as chemicals or fuel
procured ◆ Instruction manuals are not received or are written in a foreign
language
◆ No local after-sales support is available
Equipment that ◆ Equipment is technically and/or economically obsolete upon

does not fit medical arrival, or soon after its arrival
and technical ◆ Transport incubators are not transportable
requirements ◆ Generators have insufficient capacity to supply the hospital’s
power requirements
◆ Taps in the theatre scrub-up rooms are not elbow or foot operated
◆ Beds cannot be tilted
◆ Gas gauges are not compatible with local gas fittings
◆ There are items which no-one knows how to use
Poor quality ◆ Quality is so poor that a few years after commissioning, much
equipment of the equipment falls apart and is hazardous
◆ Suction machines do not suck
◆ Heavy workload areas receive lightweight equipment
◆ Filing cabinets for X-ray film cannot bear the weight of films
◆ Trolleys are so narrow that the patients fall off them
Equipment that cannot ◆ The site is not suitably built or provided with service supplies
be installed ◆ No expertise is available to install or commission the equipment
◆ Requirements and responsibilities for installation and
commissioning are not defined.
Properly written generic equipment specifications also enable you to conform to the
standards set by government, and to continue to meet the standardization policy of
your health service provider (Section 2.1).
Who Is Responsible for Developing Generic Equipment

Specifications and Technical Data?
In some countries, health service providers have already developed specifications
and technical data for equipment at most, if not all, levels of the health system. If no
such specifications and data exist, your HTM Working Group or a smaller
Specification Writing Group needs to develop specifications plus technical data for
equipment which is commonly used. Since this is a skilled technical task, staff may
require extra training or consultancy support.
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Did you know?

Many countries suffer from using poor equipment specifications. Common mistakes include:
◆ the product description is too short, providing an insufficient description of what is
required. For example, a specification which says: ‘Please supply one autoclave’ is useless. It
gives no details at all about the type of unit, what needs to be autoclaved, its size, or how it
will be powered (by electricity or kerosene). Many different sorts of autoclaves could be
supplied, most of which will be unsuitable.
◆ the product description is too rigid. If the description provided is not general enough, this can
be very limiting. For example, a specification which states: ‘Please supply one X-ray machine
like a Siemens model Unistat 11’ is so specific that most suppliers (other than Siemens) cannot
help. The only exception to this rule would be if you actually wanted to buy a particular make
and model of machine (for example, if you have standardized to it – Section 4.4).
◆ the product description reduces your options, by providing a description of particular
equipment rather than the function you require. For example, a specification which states:
‘Please supply one peristaltic pump for diffusion’ means that all you will be offered is
peristaltic pumps. If instead you say you want to undertake infusion with the best available
pump, you widen the choice of different available pumps that suppliers can offer.
Preference
To have a central library of generic equipment specifications that are used across the whole of
your health service organization. This is preferable to allowing each facility to write their own
specifications (though even this is better than having no specifications at all).

HTM Working Groups Write the specifications and technical data and
(or the smaller Specification develop a library of such resources.
Writing Group)
Central Level Ideally, develop generic equipment specifications
and technical data for the health service
organization as a whole. This is sensible, since the
Central Level is far more likely to have the
necessary technical skills, and access to technical
information and support.
Facility and Can develop generic specifications and technical
District/Regional Levels data suited to their own equipment levels.
Tip • Your health service provider might not have developed generic equipment
specifications for all equipment types suitable for different health service levels.
Do not let this prevent you from developing the specifications you need at your
health facility for your own purchases and donations.
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How to Write Generic Equipment Specifications and Technical Data

Ideally, you should develop equipment specifications and technical data for all
equipment purchases. This will help ensure that you buy the right equipment for
your needs, and will minimize your risk of experiencing problems later on.
Tip • To begin with, the task of writing Generic Equipment Specifications may appear
overwhelming. A simple way to start might be to take a critical look through the
specifications of neighbouring countries. (Information on specifications
developed by a variety of agencies and countries is provided in Annex 2). You
could simply adapt existing specifications for your own country’s situation, if you
do not have the resources or central support for a full exercise.
For HTM Working Groups at Regional/ District and Facility Level where there may
be limited management skills (Section 2.2), making comparisons with other
specifications may be the simplest way forward.
At central level you may require some computer software to assist you in undertaking
the clinical and technical research and writing. If the centre is also compiling and
overseeing specifications for the whole health service, computers and software will
make the task easier. For further details on available software products, see Annex 2.
Contents of the Specification

The length of the specification will vary, depending on the item being purchased. For a
simple item, the specification may consist simply of a brief description, with few details.
For a more complex item, it will be necessary to itemize the product requirements, so
that the specification may run to several pages (see Annex 4 for an example).
When drawing up specifications, you will need to conform to the aims of your Model
Equipment List (Section 4.3). Take care not to specify a performance higher than
you need, (though you should also bear in mind any future medical developments
that may take place during the lifetime of the equipment). Equipment that is more
complex than actually required is needlessly expensive, more difficult to use, and
more costly to maintain. You can avoid the model being obsolete by asking the
manufacturer for the latest technology or latest model that meets your
specifications (be aware that simply asking for the latest model may provide you
with the most advanced model).
When writing the specification:

◆ Describe precisely and clearly what function you want the equipment to be able
to perform, together with its technical and operational criteria. You can then look
for suppliers who can provide equipment to meet your needs, at the most
attractive terms.
91
◆ Where possible, avoid limiting yourself only to the brand names you can
remember at the time. Often, other brands could be equally suitable.
◆ Occasionally, you may have a standardization policy that requires a particular make
or model to be provided (for example, you may decide that some of your machines
should be a particular model in order to save money on accessories or
consumables, or to ensure it can be used and maintained). In this case, you should
purposely describe the equipment by its make and model. Bear in mind, though,
this can present difficulties with some donor and funding agencies (see Guide 3).
Box 20 describes the sorts of information that you should include in your
specifications.
BOX 20: Contents of a Typical Equipment Specification
Element Examples
Description of ◆ Describe what the equipment should be used for.
the equipment, ◆ Describe what the equipment should do – its purpose, scope, function and
and quantities capabilities (that is, the output required).
◆ Describe the design and features you want, taking into account factors such as
performance to be achieved, and technical characteristics as follows:
- operational requirements
- versatility of the equipment
- safety requirements (in other words, the manufacturing standards equipment should
comply with). Where you cannot provide a standard, specify that the equipment
should match the authoritative standards appropriate to the country of origin (for
example, DIN – German Industrial Norms, BS – British Standard, or others)
- quality expected
- durability
- energy saving features
- physical characteristics (for example, construction/material requirements, colour
and finish, unit or pack size, power-type, whether or not it is portable).
◆ Describe what preferences you have when there are alternatives (for example,
whether you want wheels, handles, a drying cycle, extra facilities, whether it must
be made of plastic).
◆ Include any restrictions on country of origin.
◆ Include the expected performance or output, but do not necessarily define how
this should be achieved.
◆ Try to use common titles for equipment that are widely understood by various
countries. For example, the United States uses a United Medical Devices
Nomenclature System (UMDNS). Other manufacturing countries have developed
their own systems, and the European Commission is trying to combine these as a
Global Medical Devices Nomenclature (see Annex 2).
◆ If the goods you are purchasing are not whole pieces of equipment, but are simply
accessories, consumables, and spare parts for existing equipment, you must provide
technical details of each item. You must also specify the make, model and year of
manufacturer of the equipment that they are used with (see Guides 4 and 5).
Continued opposite
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BOX 20: Contents of a Typical Equipment Specification (continued)
Element Examples
‘Package of inputs’ The ‘package of inputs’ may include any or all of the following:
required, with ◆ Accessories (for example, shelves, mains lead, patient cables, hand-pieces). Outline
quantities. all the accessories you need to last a specified length of time (at least two years),
This must cover together with sizes, types and quantities. Usually, it will be necessary to purchase at
everything else least three sets of accessories – one ‘in use’, one ‘being cleaned’, one ‘as spare’.
you need to use ◆ Consumables (for example, electrodes, breathing circuits, gel). You will require a
the equipment stock to last a specified period of time (at least two years), although you should also
over its entire take into account expiry dates and short-life items. You must detail the exact type
lifetime. and number of consumables. (It may be advisable to make them conform to the
types and sources of existing supplies, so that existing stocks can be rationalized).
Remember that, while some equipment uses standard supplies, other equipment
requires specific supplies and you will need to order accordingly.
◆ Spare parts (for example, bottles, switches, o-rings, gaskets). You will require a
stock to last a specified period of time (at least two years). You must detail your
requirements for both planned preventive maintenance and typical repairs. This
should be based on your experience, knowledge of the technology, and the
manufacturer’s recommended list.
◆ Manuals – you will require both Operator and Service Manuals including circuit
diagrams. It is advisable to obtain two copies of each.
◆ Warranty – you must specify that the guarantee should last for at least 12 months
from delivery or the end of commissioning, not 12 months from the shipping date
(since if the goods spend six months getting to you, you will have lost half the
guarantee period). If the equipment is not going to be used for some time after
delivery, special arrangements must be made with the supplier to re-define the
warranty period.
◆ Delivery – you must specify the freighting arrangements, by air, sea, or road. Also
include details for the packing and crating for freight, the destination, and the
delivery date or delivery period (number of weeks). Try to use common INCO
terms (for trade transportations). These can be found on the internet (world wide
web) with good explanations, and should be checked before use as they are
occasionally updated (see Guide 3).
◆ Insurance – you must specify whether you want the goods to be insured during the
delivery period. Some countries require all imports to be insured locally. Make sure
you specify any rules that apply.
◆ After-sales support (the supplier’s general capacity to deliver technical and
commercial know how after delivery) – specify whether you require this to be
available locally, and outline the sort of support required. In addition, ask for a price
for a maintenance contract (for reference, in case it is needed).
Continued overleaf
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BOX 20: Contents of a Typical Equipment Specification (continued)
Element Examples
For some ◆ Site preparation details – you must ask for the technical instructions and details
equipment, such from the suppliers so that you can plan for this work, either in-house or by
as sophisticated contracting out.
or imported items, ◆ Installation – you must ask for help with this if it is required.
or equipment
◆ Commissioning – you must ask for help with this if it is required.
which is new to
◆ Acceptance – you must clearly detail the responsibility of both the purchaser and
you, you may also
supplier with respect to testing and/or acceptance of the goods.
need to specify
the following ◆ Training of both users and technicians – you must ask for help with this if it is
item lines: required, and for written training resources.
◆ Maintenance contract (an important part of after-sales support) – you must ask
for one of these if it is required. It will be necessary to agree and stipulate the
duration and whether it should extend beyond the warranty period, the cost and
whether it includes the price of labour and spare parts, and the responsibilities of
the owner and supplier.
Layout of the Specification

The layout of the specification is important, since details must be clear for the bidding
suppliers. Also, it should ensure that the manufacturer’s replies (his specification) can
easily be compared with your requirements (your specification). This helps when you
are evaluating bids (see Guide 3). The layout should ensure that:
◆ the specification is split into sections which describe different aspects of the item
to be purchased, and the different elements of the specification
◆ each section lists features of the equipment that the supplier must comply with.
Try to ensure that each feature is listed on a separate line
◆ equipment features are tabulated, together with columns where the supplier is
obliged to state whether their machine complies with each point, and the price of
each element
◆ the supplier is required to provide a breakdown of costs for each item/charge, as
well as a summary total cost for the overall bid.
Tip • When listing the ‘package of inputs’, it is important that you do not simply ask
the supplier to state whether or not they can supply the various services listed. If
so, you may just receive a ‘yes’ or ‘no’ answer. Instead, you must specify that they
should provide a quote for each of the services listed. This way, when it comes to
awarding the contract, you will be able to decide whether to omit certain services
if they are too costly.
An example of a layout for a long specification is shown in Annex 4.
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Figure 11 provides advice on how to write your specifications, and how to update
them over time.
Figure 11: Steps for Writing Specifications
Steps Activities
The HTM Working Group or its Specific Writing Group:
Identifies needs by consulting • Discover the requirements of the users

with potential users of the • Inspect examples of equipment and the proposed sites for
equipment being considered new equipment
• Take advice from experts and consultants, if necessary
Identifies possible solutions by

referring to any available • Study equipment brochures, guides, manuals and catalogues.
information about equipment
Clarifies any queries by

contacting manufacturers and • Ask for data and clarifications regarding available products.
suppliers
Compiles information and starts

• Look at the guidance on writing specifications provided in this
writing the specification according
section
to an agreed layout
Improves the content of the

• Look at other people’s generic equipment specifications and
specification by studying existing
your Model Equipment List (Section 4.3)
resources
Clarifies the types and quantities • For guidance refer to the ‘registers for new stocks’
of consumables, accessories, (completed for newly purchased equipment on arrival –
and spare parts required see Guide 3)
Finalizes the contents by • Check for drawbacks shown by the performance of existing
obtaining feedback from current equipment and supplies (Section 8.2), and use this to revise
users and maintainers the specification.
Adds the specifications to the • Write new specifications for new products and applications on
library the market
Ensures the specifications are

• Provide the procurers with the specifications to include in the
used when equipment is
purchase documents (see Guide 3)
purchased
• Regularly update existing specifications in response to

Revises and updates the
changes in technology and feedback on the performance of
specifications periodically
equipment and supplies (Section 8.2)
Technical and Environmental Information

As well as providing details of the types of equipment and support services required,
your purchase documents also need to include technical and environmental data. Such
data describes the types of environment and surroundings in which the equipment will
be used, and enables the supplier to offer the most suitable product for your needs.
95
There are a number of technical and environmental factors which you will need to
take into account. For example:
◆ If you have an unstable power supply, is your supplier able to offer technical
solutions (such as voltage stabilizers, uninterruptible power supply)?

◆ Will your geographical location (such as height above sea-level) affect the
operation of equipment (such as motors, pressure vessels)? If so, can the
manufacturer adjust the item for your particular needs?
◆ Extremes of temperature, humidity, and dust may adversely affect equipment
operation, and may require solutions provided by either you or the manufacturer,
such as air-conditioning, silica gel, polymerized coatings for printed circuit boards,
and filters.
You may include this information within the generic equipment specifications.
However, since much of the information is common to many pieces of equipment,
some health service providers have found it simpler to develop a separate summary
Technical and Environmental Data Sheet, which can be referred to in the
purchase documents. This data sheet can be distributed to all suppliers, interested
parties, trade delegations and other relevant bodies. Such a data sheet can be
provided regardless of the length of specification or the procurement method used,
ensuring that all parties are kept informed of prevailing national conditions which
could affect the operation of equipment.
When compiling a Technical and Environmental Data Sheet, you should include
details of:
◆ Electricity supply – mains or other supply, voltage and frequency values and
fluctuations
◆ Water supply – mains or other supply, quality and pressure
◆ Environment – height above sea-level
– mean temperature and fluctuations
– humidity
– dust level
– vermin problems
◆ Manufacturing quality – international or local standards required
◆ Language required – main and secondary
◆ Technology level required – manual, electro-mechanical or micro-processor
controlled.
You can develop a general data sheet for your country, or make more specific ones for
your region, or your health facility. A sample of a Technical and Environmental Data
Sheet is given in Annex 5, and its use is discussed further in Guide 3 on
procurement and commissioning.
Figure 12 provides advice on how to write your technical and environmental data
sheet, and update it over time.
96
Figure 12: Steps for Writing Technical and Environmental Data Sheets
Steps Activities
The HTM Working Group or its Specific Writing Group:
Identifies the technical contents • Find out what the local conditions are
required by consulting with users • Investigate the differences between sites if the data sheet
and maintainers covers more than one facility
• Take advice from experts and consultants, if necessary.
Clarifies any queries by contacting • Ask for data and clarifications from bodies such as the
relevant national agencies meteorological office, land survey office, water board,
electricity authority, etc.
Compiles information and starts • Look at the guidance on writing data sheets provided in this
writing the data sheet section.
• Write new data sheets if products are purchased for facilities

Adds the data sheet to the library
not previously covered by existing data sheets.
• Provide the procurers with the data sheets to include in the

Ensures the data sheets are used purchase documents (see Guide 3)
when equipment is purchased • Supply other relevant bodies with the data sheets, such as
external funding agencies, trade delegations.
Revises and updates the data • Update existing data sheets if any factors or circumstances
sheets periodically change.
Once you have gone through the one-off exercises to establish the planning tools, as
described in this Section, you can use them to make your long-term plans (Section 7)
and to undertake annual planning (Section 8.1). You will also need to update the
tools on a regular basis. This process is described in Section 8.2.
BOX 21: Summary of Procedures in Section 4 on Discovering Where You are Headed
HTM Working ◆ use the strategies in Box 12 to obtain as much literature as possible
Resources
Groups ◆ develop a reference library, and ensure the resource materials that staff require are
(at all levels) available
Health ◆ investigate the cost of subscriptions, and other resources which must be purchased
Management ◆ compile lists of resources to present to external support agencies for assistance
Teams
◆ use the reference materials for equipment planning and budgeting purposes
Continued overleaf
97
Section 4 summary
BOX 21: Summary of Procedures in Section 4 on Discovering Where You are Headed (continued)
Health Service ◆ take responsibility for defining the Vision for the health services which are to be
Provider provided
and Health ◆ use the Vision for equipment planning and budgeting purposes
Management
Teams
Vision
HTM Working ◆ consider the technology implications of the Vision, and feed back to the Health
Groups Management Team at your level, in order to inform the debate
(at every level)
Equipment ◆ participate in a series of meetings held at each level to develop the Vision (see
Users and Boxes 13–15)
Section Heads
Health Service ◆ take responsibility for developing the Model Equipment Lists, and computerizing
Provider them
and Health ◆ use the Model Equipment Lists for equipment planning and budgeting purposes
Management
Model Lists
Teams
HTM Working ◆ organize a series of consultation meetings with staff from different disciplines, and
Groups develop the Model Equipment Lists (see Box 16)
(at every level)
Equipment ◆ participate in a series of meetings held at each level to develop the Model
Users and Equipment Lists
Section Heads
S p e c s a n d D a t a B u y / R e p l a c e Po l i c i e s
Health Service ◆ address the practical issues involved in implementing the equipment purchase,
Provider donations, replacement, and disposal policies, and introduce them and their
and Health implications to the Heads of Section
Management ◆ ensure replacement equipment is purchased when equipment is condemned at the
Teams end of its life (see Guide 4)
HTM Working ◆ use these policies for equipment planning and budgeting purposes
Groups
(at each level)
and Section
Heads
HTM Working ◆ take responsibility for developing generic equipment specifications (see Figure 11)
Groups ◆ take responsibility for developing technical and environmental data sheets (see
(or Specification Figure 12)
Writing Groups)
Procurement ◆ use generic equipment specifications and technical and environmental data sheets
Officers (in the during procurement negotiations with suppliers (see Guide 3).
health services,
and external
support agencies)
98
5. How to make capital budget calculations – budgeting tools I
5. HOW TO MAKE CAPITAL BUDGET

CALCULATIONS – BUDGETING TOOLS I

Capital funds are required annually to cover large one-off expenses. These
may include such expenses as replacing existing equipment, buying additional
(new) equipment, getting new acquisitions to work, and undertaking major
equipment rehabilitation projects.
Failure to allocate sufficient funds for these items could result in insufficient
equipment for your needs, or new items which cannot be utilized for several
months because there is nobody to install or test them.
This Section provides advice on how you can learn to budget for all these costs.
The planning tools (Sections 3 and 4) will help you to identify what you want to
replace, purchase, or rehabilitate. However, you should only introduce changes if you
can afford them. This is determined by budgeting for equipment, according to the
principles and budget calculations outlined in this Section.
In this Section, we outline some ‘budgeting tools’, which will help you to understand
how to make various calculations for capital costs. Different calculations are
described for the different health service levels. These calculations can then be used
to make your plans and budgets, as described in Sections 7 and 8.1.
As Section 3.3 explains, one reason why capital expenditure is required each year is
to cover the need to purchase equipment. All capital allocations should be made in
accordance with the priorities given in your Purchasing and Donations Policy
(Section 4.4.2). In other words, funds should be spent on equipment for the
following reasons and in the following order of priority (see Box 17):
1. for replacement
2. to obtain a basic standard level of care
3. to upgrade the level of health service provided by the facility
4. to provide items outside your plan only if forced to because of directives from
higher authorities.
The capital funds must also cover:

◆ All other expenses that are associated with acquiring equipment, such as:
- pre-installation work
- support activities which ensure that you can use the equipment (installation,
commissioning and initial training).
◆ The cost of major equipment rehabilitation work which cannot be covered by your
usual annual recurrent allocation.
99
Therefore, in order to be able to make adequate allocations, you need to be familiar

with various budgeting tools. This Section covers five budget calculations for capital
allocations:
◆ replacing equipment (Section 5.1)
◆ purchasing new equipment (Section 5.2)

◆ pre-installation work (Section 5.3)
◆ support activities so you can use your purchases (Section 5.4)
◆ large-scale major rehabilitation projects (Section 5.5).
In this Section, different ways of calculating budget elements are given. They are
used for different purposes, as follows:
a. Rough Estimations – used for long-term plans, business purposes, and
bulk purchasing
– most often used at central or regional levels
which cover the needs of many facilities and
cannot go into specific details.
b. Exact Detailed Estimates – used for annual requirements and specific single
purchases
– most often used at facility or district level.
Tip • Whenever new equipment is acquired, it is vital to budget for its running costs.
Therefore, there must be a link between planned capital expenditure and
recurrent budget estimates for things like maintenance and consumables. The
recurrent budget calculations are described in Section 6.
In many developing countries there is a recurring cycle:

◆ capital budgets are only allocated when funding is available from external support
agencies
◆ health facilities are often funded through foreign aid and constructed as turnkey
projects
◆ the useful lifetime of these facilities can be less than 10–15 years (if not well
maintained)
◆ rehabilitation thus becomes a huge burden on the health service provider.
As Figure 13 shows, such a cyclical approach to funding is costly and provides little
benefit to patients. If such an approach is followed, the quality of the health service
delivered will not be constant and will undergo frequent periods of deterioration.
It is important for budget estimates to reflect this danger. Therefore, you should
plan the replacement of your equipment and facilities in gradual stages, in order to
secure annual capital budget requirements.
100
Figure 13: The Danger of a Cyclical Approach to Funding Equipment
Slope A:
– inadequate maintenance
– lack of spare parts
New – no planned replacements Rapid
equipment deterioration
Slope B:
– rehabilitation and restocking
Functioning
stock of
equipment
for health
service A B A B A
delivery
Injection of Injection of
funds funds
Time
5.1 REPLACING EQUIPMENT

Budgeting for replacement is necessary, since all equipment has a life expectancy.
Once equipment has reached the end of its life, no amount of intervention will be
effective. Instead, you will simply have to replace the equipment if you want to carry
on delivering a quality health service.
Different types of equipment have varying life expectancies, depending on the type
of technology contained within them. For example, five years might be the typical
life for an oxygen tent, 10 years for a respiratory ventilator, 15 years for a dental chair,
and 20 years for a lift. It has been necessary to develop estimates for equipment
lifetimes, although it must be recognized that these lifetimes will vary for different
users. This will depend on a number of factors, such as:
◆ the rate of use of the equipment (how many tests per month, how many patients
per year, etc.)

◆ how many back-up units there are – whether a machine is used to its limit,
overworked or overloaded
◆ how the equipment is handled or whether it is abused
◆ how well the equipment is cared for and cleaned
◆ how well the equipment is maintained and how often
◆ the initial quality of the equipment
◆ the physical environment and climate that the equipment is used in.
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5.1 Replacing equipment
Annex 3 contains some typical lifetimes for equipment which have been developed
by various organizations. Over time, and based on your experiences, you can modify
these figures to suit your circumstances. But you need to start somewhere and these
figures provide a basis for planning purposes.
An annual replacement budget covers the needs of equipment likely to reach the
end of its life in any given year. This simply covers the normal demise/death of the
proportion of existing stock which reaches the end of its life in that year.
By providing the finance for this replacement equipment, the health service
provider is simply sustaining existing services and is not financing expansion.
For example, if a health facility wishes to continuously provide a dental service, the
dental drilling unit needs to be replaced at the end of its life so that the existing
service can continue. The purchase of a replacement drilling unit is not an expansion
in dental services, but is merely a continuation of the existing provision.
Thus replacement funds need to be provided routinely, and are required for
different reasons than funds allocated for the purchase of additions to the
equipment stock under facility expansions and upgrading projects.
Failure to replace equipment will result in soaring maintenance bills as the

equipment ages (see Figure 19 in Section 6.1). Also, if many years go by without an
annual replacement budget, your health service provider will face a critical reduction
in the healthcare they can deliver. You will accumulate an increasing backlog of
expired equipment. This means you will ultimately face the major capital
investment implications of having to undertake bulk replacement of equipment
stock all at once. This is not usually affordable or manageable.
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What Budgeting for Replacement Implies

If replacement is not planned for, the health service delivered to the public will
simply deteriorate. As a quick estimate, you need to make the following calculation,
using the stock value estimates developed in Section 3.2:
equipment stock value in new (current) prices = replacement budget required

equipment lifetime each year
BOX 22: Principles Behind Replacement Cost Calculations
A. Basic Principle
Assuming – your equipment stock value (Section 3.2) is, for example, US$2,500,000 (Note: this is not
based on what you buy each year, but upon the value of all the items you already own)
And – all the equipment only had a ‘life’ of one year
Then – you would need $2,500,000 each year to replace your equipment!
B. Taking Equipment ‘Life’ Into Account
But – if the ‘life’ of the equipment is, in fact, five years
Assume – the equipment will not all reach the end of its life at the same time
Then – you can spread your replacement budget over the equipment lifetime, as follows:
replacement budget each year = value of stock

lifetime
For example: replacement budget per annum = 2,500,000 = $500,000 pa

5
C. Averaging Across All your Stock
In fact, your stock will actually be made up of different types of equipment with different lifetimes – some
five years, some 10, some 15, and some 20 years. Based on such lifetimes, an average lifetime is often taken
to be 10 years. Thus, a rough estimate of the replacement budget will need to be 10 per cent of the
equipment stock value each year:
replacement budget each year = total stock value

average lifetime
For example: replacement budget per annum = 2,500,000 = $250,000 pa

10
D. Averaging Across Types of Equipment

To make more exact estimates, it will be necessary be more specific and undertake calculations for each
different type of equipment that has a different lifetime (see Annex 3). For example, your stock of
equipment may be made up of:
$750,000 worth of stock with a ‘life’ of 15 years
$1,300,000 worth of stock with a ‘life’ of 10 years
$450,000 worth of stock with a ‘life’ of five years
Therefore, each year you will need a replacement budget of:
750,000 + 1,300,000 + 450,000 = 50,000 + 130,000 + 90,000 = $270,000 pa
15 10 5
103
In Box 22, Examples A and B explain the basic principles behind the calculations.
Such calculations can be undertaken for all types of equipment clumped together to
give an average estimate, as shown in Example C. Or calculations can be undertaken
for different groups of equipment with different lifetimes to provide a more accurate
estimate, as illustrated in Example D.
Tip • If we consider that typical equipment lifetimes range from approximately five to 20
years, an average equipment lifetime can be taken to be 10 years. Thus, as a rough
indicator, the replacement budget would need to be 10 per cent of the equipment
stock value each year. This has a significant implication for health finances.
It is very common for health service providers to undertake no regular planned

replacement budgeting, even though such a practice is commonly used in the
business community. We recognize that adequate replacement budgets may work
out to be a large percentage of the overall health budget. Thus replacement needs
are often not covered regularly but are left to fall under occasional development
projects, funded either by the health service provider or external support agencies.
Although it may be difficult to set aside the recommended amounts to cover all
replacement needs, your health service provider must start somewhere. They should
start with at least some percentage of the equipment stock value. If they do not,
they face the long-term cost implication of deteriorating facilities, lost ability to
function, and failure to deliver health services.
Who is Responsible for Replacement Budgeting?

HTM Working Groups Need to learn how to budget for equipment
Finance Officers replacement.
Any health facility that: Can make equipment replacement budget
- makes its own plans calculations.
- sets or requests its own
budget allocations
- runs its facility as a business.
Any service level that: Can use the rough estimations described here for
- covers the needs of many long-term forward plans and budget allocations
facilities
- develops business plans
- wants a general idea of
needs
Any service level that makes Can make more exact detailed estimates as
detailed estimates for: described in Section 5.2
- specific single purchases.
- annual requirements.
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How to Budget for Replacement

When budgeting, you should aim to allocate sufficient funds for future needs. We
recommend that you actually put aside money in your budget each year, to cover
equipment replacement costs. This is not simply the book-keeping paper exercise of
depreciation accounting. (Depreciation accounting is when you write off part of the
value of your stock each year to show that your assets are worth less than they used
to, and to reflect the revised value of your business).
Figure 14: How To Make Rough Estimations of Replacement Costs for Forward Planning
Process Activity
HTM Working Groups and/or Finance Officers:
Use the up-to-date

Refer to existing documents equipment stock values and
equipment reference price
lists (Section 3.2)
Use one of the following

Calculate the annual methods, depending on the
replacement equipment type of financial projections
budget requirements you require in your
busininess plan:
Cost the Model Equipment List (Section 4.3)

If you want an ideal
for your type of facility. Then calculate 10
estimate for your
per cent of this ideal value, for the annual
type of facility
equipment replacement requirement.
If you want a more Cost the existing Equipment Inventory

realistic estimate (Section 3.1) for your facility. Then calculate
based on your 10 per cent of this realistic value, for the
current stock annual equipment replacement requirement.
Identify and cost only certain equipment

areas to concentrate on for replacement in
If you want a more
the current year. Then, calculate the
pragmatic/practical
replacement costs for this pragmatic stock
estimate for your
value, according to the methods given in
most urgent needs
Examples C or D (in Box 22) and their
expected life-times (see Annex 3).
If you are short of As a bare minimum, at least set aside some

money but want to percentage of the equipment stock value
start somewhere (Section 3.2) each year.
Make allowance for the Was your maintenance As a bare minimum, at least set aside some
assumptions made when budget based only on the If so, increase
percentage of the replacement
equipment stockbudget,
valuein
calculating the maintenance small proportion of current order
(Sectionto return a further
3.2) each year. proportion of the
budget (see Figure 20 in equipment stock which can equipment stock to a repairable condition.
Section 6.1) be rehabilitated?
105
5.2 Purchasing new equipment
When budgeting for replacement costs, you should make:

◆ rough estimations for long-term forward planning purposes, as shown in Figure 14.
Then, once you are in a position to make the actual purchase of the replacement
equipment, you can make:
◆ exact estimates for the specific equipment purchases, as shown in Box 23 or
Boxes 24 and 25 in Section 5.2.
5.2 PURCHASING NEW EQUIPMENT

Whenever you purchase equipment, you need to budget for more than just the cost
of the hardware. You must also budget for:
◆ the cost of the total ‘package of inputs’ (e.g. maintenance, training, consumables)
required to keep the equipment functioning
◆ the costs of getting the equipment to your facility in a working condition.
A common mistake is to identify the supplier’s price for the goods required, and
assume that this is the total amount that you must budget for. In fact, there are many
other expenses involved when procuring equipment which need to be included in
order to identify what will be the total cost to you. You also need to take into account
the following expenses:
◆ the price of the equipment
◆ the cost of a ‘package of material inputs’ required for you to use the equipment.
This would include items such as accessories, manuals, stocks of consumables and
stocks of spare parts
106
◆ the cost of a ‘package of support inputs’ required in order to get the equipment
going. This would include items such as assistance with installation,
commissioning and initial training
◆ the cost of freighting the goods to your facility (for example, crating, international
shipment by sea or air, insurance, import duties, customs clearance and onward
transport by road/rail to your facility)
◆ any procurement charges, if you are paying an agency to undertake the purchasing
for you.
Also, there may well be additional costs that are often forgotten, such as:
◆ the cost of pre-installation work, such as site preparation, additional equipment
needs (for example, air-conditioners or voltage stabilizers), hire of fork-lift trucks
and storage costs (Section 5.3)
◆ the annual maintenance contract required (Section 6.1)
◆ the cost of employing extra staff. This implication needs to be identified and
agreed in the planning stage, before the purchase goes ahead (Section 4).
All these costs will vary, depending on the purchase options you make (see Guide 3).
This will depend on factors such as:
◆ the type of technology you purchase
◆ whether you import the equipment

◆ whether you buy in bulk
◆ whether someone else is undertaking the procurement for you.
It is also important to look for savings, such as negotiated discounts. For example,
you may be able to lower your purchase costs by collaborating with other facilities or
service levels, and buying equipment together in bulk. Using this method will also
help you to standardize the makes and models purchased. Section 2.2 discusses such
issues of economies of scale.
Who is Responsible for Budgeting for Purchases?

HTM Working Groups Need to learn how to budget for equipment
Purchasing and Supplies purchases.
Officers
Any facility or service level Can make equipment purchase calculations.
that:
- makes its own plans
budget allocations
- runs its facility as a
business.
107

Central or regional service Are more likely to make rough estimations for
levels that: long-term forward plans and budget allocations.
- cover the needs of many
facilities
- cannot go into specific
details.
Facility or district service Are more likely to make more exact detailed
levels that make estimates estimates.
for:
- specific single purchases
How to Cost New Equipment Purchases

If budgets are based solely upon the initial price of the equipment quoted by the
supplier, it is likely that they will be inadequate.
Thus, for real purchase costs, you can make:

◆ either rough estimations for long-term forward planning purposes and bulk
purchases, as shown in Box 23

◆ or exact estimates for specific or annual requirements, as shown in Boxes 24 and 25.
BOX 23: How To Make Rough Estimations of Equipment Purchase Costs for Forward
Planning and Bulk Purchasing
HTM Working Groups and/or Purchasing and Supplies Officers:

1. When buying a consignment of assorted items, aim to make an estimate averaged over the whole range of
the assorted equipment being purchased.
2. Start with the total bulk price of the equipment from the manufacturer (or see reference price lists in
Section 3.2).
3. Make the following calculations to estimate what the real cost might be:
Calculation Example
a. Take the (bulk) price of the equipment: US$ price = $20,000
b. Allow for the ‘package of material inputs’
by calculating: 110% of price = package value = $22,000
c. Allow for the ‘package of support inputs’
by calculating: 110% of package value = working value = $24,200
d. Allow for the freighting costs by calculating: 110% of working value = delivered value = $26,620
e. Allow for procurement charges by calculating: 110% of delivered value = Total Cost = $29,282
4. Consider whether any additional money is required for pre-installation work.

Make these calculations according to Box 26 in Section 5.3.
108
BOX 24: How To Make Exact Estimates for Specific Equipment Purchases
HTM Working Groups and/or Purchasing and Supplies Officers:
1. When buying single items or types of item, aim to consider each piece of equipment or similar types of
equipment separately.
2. Contact the manufacturers or suppliers for the initial basic price of their available products (or see
reference price lists in Section 3.2).
3. Make the following calculations to estimate what the real cost might be:
◆ Imagine equipment falls into four categories which are dependent on how technically complicated it
is, and therefore how many skills and resources are required for it (as shown in Box 25).
◆ Choose the correct category for the equipment you are trying to purchase.
Then look up that category in Box 25 to find out the actual cost estimate required.
4. Use these total cost estimates (rather than the supplier’s initial price) when budgeting for specific
replacement and additional equipment purchases, which have been planned and agreed (Sections 7
and 8.1).
Box 25 helps you to see the impact of purchasing types of equipment of varying
complexity and technology levels.
4
BOX 25: Total Purchase Cost Estimates depending on Equipment Type
Price Category A: High technology sophisticated equipment requiring special spare parts. Most repair and
preventive maintenance is undertaken by specialists. Normally comprehensive training of clinical and
technical staff is required.
Price Category B: Medium technology equipment requiring special spare parts. Repair and preventive
maintenance can usually be undertaken by local staff. Training of clinical and technical staff is required.
Price Category C: Low technology equipment requiring easily obtainable spare parts. Repair can be
undertaken by local labour. Little or no training of staff is required.
Price Category D: Simple equipment and furniture requiring little or no spare parts. Repair can be
undertaken by local labour. No training of staff required.
Equipment Price Categories
COSTS A B C D
1. Net Procurement price Free-On-Board (i.e. at the port of exit

of the supplier’s country) 100%1 100% 100% 100%
2. Package of inputs (accessories, consumables, manuals, etc.)

2
for estimated one year of operation 7% 5% 3% 2%
3. Installation, commissioning, plus initial training of

key personnel 15% 10% 5% 0%
4. Spare parts for estimated two years of normal operation 20%3 10% 2.5% 0.5%
Continued overleaf
109
4
BOX 25:Total Purchase Cost Estimates depending on Equipment Type (continued)
Equipment Price Categories

COSTS A B C D
5. Freight charges, dependent on whether coming from

neighbouring countries (eight per cent) or from overseas
(15 per cent) 8–15% 8–15% 8–15% 8–15%
6. Insurance 1.5% 1.5% 1.5% 1.5%
7. Contingency 3% 3% 3% 3%
8. TOTAL4 if freighting from neighbouring countries 154.5% 137.5% 123% 115%
TOTAL4 if freighting from overseas 161.5% 144.5% 130% 122%
Possible Additional Costs
9. Charges of a Procurement Agent 10% 7.5% 5% 5%
10. One year’s service support 7% 5% 1.5% 0.5%
5
11. Unloading/lifting equipment and warehousing – dependent on
size and weight; if small/light (nought per cent), if large/heavy
(one per cent) 0–1% 0–1% 0–1% 0–1%
12. Site preparation work5 – dependent on size and portability;

if small/portable (nought per cent), if large/fixed (10 per cent) 0–10% 0–10% 0–10% 0–10%
Notes:
1. The initial basic price for the equipment which you obtain from the manufacturer or supplier is the
amount to appear in the first row (100 per cent).
2. These percentages are calculated from the basic price provided by the supplier (in row 1).
3. For sophisticated equipment you may not hold the spares yourself, but will budget to pay the
manufacturer’s representative to obtain them or hold them for you.
4. The real total cost that you will have to budget for will be greater than 100 per cent of the initial price,
and will be the percentage shown in the Total row (row 8), with possibly the additional costs shown in
rows 9–12.
5. See Box 26 (in Section 5.3).
When negotiating with donors, it is very important to ensure that they finance this
full ‘package of inputs’. There are examples of good foreign aid projects where the
whole package has been planned for. Unfortunately, however, there are also many
examples of poorly planned projects, where equipment has failed to work from the
beginning, due to the lack of consideration of these inputs.
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5.3 Pre-installation costs
5.3 PRE-INSTALLATION COSTS

Once equipment has been purchased, further work may be required, in order to
prepare the facility for the arrival and commissioning of the equipment. If you do not
allocate sufficient funds for this, your new equipment may sit for many months before
you are able to use it. It is best to build the extra expense of pre-installation work into
the capital allowance you set aside for equipment purchases, as this is when capital
funds are available. If you discover you need money for pre-installation work after the
equipment has arrived, it is then more difficult to find additional funds.
A variety of necessary work and tasks commonly fall under the category of ‘pre-
installation work’. These could include:
Site preparation tasks, such as:

◆ disposing of the existing obsolete item (disconnection, removal, cannibalizing for
parts, transport, decontamination and disposal)

◆ extending pipelines and supply connections to the site (from the existing
service installations)
◆ upgrading the type of supply (such as increasing the voltage, or the
pipeline diameter)
◆ providing new surfaces (such as laying concrete, or providing new worktops)
◆ creating the correct installation site (for example, digging trenches, building a
transformer house or a compressor housing).
Hiring lifting equipment (such as cranes, forklift trucks, stores trolleys, gangs of
labourers):
◆ to help with lifting equipment for unloading/moving purposes
◆ to help with lifting equipment for installation/positioning purposes.
111
Paying for warehouse space:

◆ if goods are stored by Customs because you have delayed their clearance or have
not paid the duty, then Customs will impose charges on you
◆ if equipment has to be stored when it arrives until you are ready to install it.
All of this ‘pre-installation work’ requires funding, if the equipment is to be usable

once it arrives. Often, this work requires substantial amounts of money.
Experience in a West African Country

A donor agency financed large amounts of new equipment but assumed the central
health service could finance the pre-installation work. However the cost of such work
was found to be so large it required external support funding of its own.
Who is Responsible for Calculating Pre-Installation Costs?

Preference
Guide 3 of this Series covers in detail the activities involved during procurement and
commissioning of equipment. We suggest that the HTM Working Group, or a smaller
Commissioning Team (Section 1.2), is responsible for ensuring that pre-installation work is
organized, financed and implemented.

HTM Working Group, or a Need to learn how to budget for pre-installation
smaller Commissioning work
Team (Section 1.2)
Any health facility or service Can make pre-installation work calculations
level that:
budget allocations
- runs its service as a business.
A service level (such as Will find the calculations for exact estimates most
facility or district) that makes useful
detailed estimates for:
Any service level that Can use the calculations described for exact
undertakes bulk purchasing, estimates
needs an exercise to
estimate the pre-installation
requirements at the variety
of sites they purchase for.
112

Service levels (such as Only need to make rough estimations for their
central or regional/district long-term forward plans and budget allocations
levels) that:
- cover the needs of many facilities
- cannot go into specific details.
How To Calculate the Pre-Installation Costs

You can make:
◆ either rough estimations for long-term forward planning purposes, by referring
to Box 26
◆ or exact estimates for specific equipment purchases, and investigate the needs
for your bulk purchases, as shown in Figure 15.
It is difficult to make global rough estimates for the cost of site preparation work
according to equipment price categories. However, Box 26 provides some
suggestions from various countries.
Box 26: Suggestions for Rough Estimations of Pre-installation Costs for Forward Planning
Different countries suggest a number of alternative approaches:

i. Advice can be obtained from:
◆ Manufacturers, who can usually provide information on site preparation and unloading/lifting needs.
These can then be used to make estimates of local costs.
◆ Local freight forwarding companies, customs, and warehousing facilities, who can provide information
on warehousing costs. Your commissioning team should be liaising with the freight forwarding
company and any installation company concerning delivery dates and expected delays, which can be
used to estimate warehousing needs (see Guide 3).
ii. Any estimates for site preparation depend on:

◆ the type of equipment involved
◆ whether site preparation involves new buildings or renovations/alterations of existing ones
◆ the state of the local construction industry
◆ local labour costs.
iii. Examples from Eastern and Southern African countries of site preparation costs are:
Equipment Price Site Preparation Needs Cost As percentage

(US$) (US$) of price
MRI unit 1 million new construction at US$1.500/sq.m 70,000 10%

Generating set
for a facility 50,000 cabling, concrete base, shed 2,500 5%
ECG recorder 3,000 none 0 0%
Water heater 200 brackets, tubing, switch, circuit breaker 20 10%
Continued overleaf
113
Box 26: Suggestions for Rough Estimations of Pre-installation Costs for Forward Planning
(continued)
Thus the site preparation cost does not always depend on the equipment sophistication, or on price
category. Sometimes, it has more to do with:
◆ the size of the equipment
◆ whether it is portable
◆ whether it requires lots of service supply connections
◆ whether it requires a housing
Average costs as a percentage of equipment price are given in Box 25.
iv. Any estimates for unloading/lifting depend upon:

◆ the type of equipment involved
◆ its weight, size, and difficulty to handle

◆ local labour costs
◆ local hire costs for cranes and forklift trucks (for example, in parts of Southern Africa it costs
US$50/hour for hiring a crane)
◆ whether the freight forwarding company has the means for unloading/lifting the equipment.
v. Any estimates for warehousing depend on:

◆ the weight and volume of the equipment
◆ the length of the storage period.

To make exact estimates, you need to know more specific details about the site, as
shown in Figure 15.
Tip • The service level which makes these calculations will have to visit the site, or
know about the site, or have relevant site and engineering drawings.
114
Figure 15: How To Make Specific Estimates of Equipment Pre-installation Costs
Step/Process Activity
1. The HTM Working Group or Commissioning Team:
Whenever equipment is purchased, provide the supplier with

details of the proposed equipment site and services, and
Liaises with the supplier
officially request the necessary site preparation instructions and
the size and weight of the crated goods.
Identify the needs and arrangements required for warehousing,

Reviews administration needs and
hiring of lifting equipment, and safe disposal of existing items.
costs
Cost the requirements.
2. HTM Manager:
Study the manufacturers’ site preparation instructions or, if these
Reviews technical needs are not available, use experience and common sense.
• What work is involved in removing the existing item and cutting

Plans removal of existing connections?
equipment • What work is involved in cannibalizing the existing item for
parts?
• Is special construction required, such as a transformer

housing or lead screening?
Plans any construction or building • Is the room large enough to accommodate the equipment?
alterations required • Are any special modifications necessary, such as enlarging
the doorway, or building a worktop?
• Do any scrap or other items need to be removed from the
room?
• Does the new equipment require a new transformer?

• Do you need a generator, or does the existing one need
upgrading?
Plans the electrical requirements • Is a single phase or three-phase supply required at the site of
installation?
• Is a special circuit breaker needed?
• Is a special socket outlet required?
• Has the existing electrical circuit sufficient capacity?
Organize an exercise to ensure that all relevant electrical

Ensures the existing electricity
installations are properly grounded and tested, and determine
installation is safe
if any remedial works are required.
• Is the water pressure available adequate?

Plans the water and drainage • Is water treatment required?
requirements • Does the pipeline diameter need increasing?
• Is proper drainage provided?
• Is the necessary steam supply available at the proposed site?

Plans any steam supply
• Does the pipeline diameter need increasing?
requirements
• Can the boiler accommodate the increased load?
Plans the gas supply Are the necessary gas supplies available at the proposed site?
requirements
Continued overleaf
115
Figure 15: How To Make Specific Estimates of Equipment Pre-installation Costs (continued)
Consider the specific guidelines relevant to certain types of

Plans any extra specific equipment, as detailed and provided by the equipment supplier
requirements for installing the (for example, placing bolts in the ceiling for attaching operating
equipment lights in theatres, trenches for waste water for dental suites and
washing machines).
Consider whether associated items are required for the

Plans any additional equipment
equipment or installation, such as an air-conditioning unit, or an
needs
uninterruptible power supply (UPS)
Draw up bills of quantities for the materials required for all the
Estimates the materials required
remedial works detailed above.
Prepare detailed costs of the work required (including any use

Calculates the costs required
of contractors if necessary).
3. HTM Working Group or Commissioning Team:

Submit the total ‘pre-installation work’ costs to the Health
Liaises with the Health
Management Team, so they can allocate budgets for such
Management Team
requirements.
4. Health Management Team or Finance Officer:

Decide which elements of the pre-installation work can be
Allocates the necessary budgets
covered by the capital expenditure budget and which should
be covered by recurrent budgets.
5.4 SUPPORT ACTIVITIES TO ENABLE YOU TO USE

YOUR PURCHASES AND DONATIONS
There are a number of activities which must take place before you can start using
equipment which has been purchased. These activities make up the official
‘Acceptance Process’ (see Guide 3) and include:
◆ receiving equipment on site
◆ unpacking
◆ installation (fixing equipment into place)
◆ commissioning (checking that equipment is performing correctly and safely)
◆ official acceptance
◆ initial training (for equipment users and maintainers)
◆ entering stocks into Stores and onto records
◆ payment
◆ complaints.
116
5.4 Support activities to enable you to use your purchases and donations
From this list of activities, health service staff must be responsible for receiving goods
on site, official acceptance, entering stocks and information into existing record
systems, and dealing with payment and complaints. These activities will not cost you
anything to undertake.
However, unpacking, installation, commissioning and initial training can be

undertaken either by health service staff or by paid external support. This ‘package
of support inputs’ will have a cost attached. How much it costs depends on the type
of technology and who undertakes the work.
Type of Technology
For common low-technology items of equipment that are simple to use, installation,
commissioning, and initial training are not major activities and will happen all at
once. For example, for a mobile examination lamp:
◆ installation is using a test meter to check the electricity supply of the socket
outlet, and then simply plugging in the lamp

◆ commissioning is using a test meter to check the electrical safety of the lamp so
that it will not give the operator an electric shock
◆ initial training is ensuring the operator knows where the on/off switch is, how to
handle the light bulb, and how to alter the angle of the head without pulling the
lamp over.
However for more complex items or for items you are not that familiar with installation,
commissioning, and initial training can become major tasks. Such activities must be
planned carefully if the equipment is to work properly from the start.
Who Should Undertake the Work?

Unpacking, installation, commissioning and initial training can be carried out either
by representatives from the supplier company, staff from your health service
provider, or another support organization.
The factors which help you to decide which type of personnel should be involved are:
◆ The level of complexity of the equipment. For example, the more complex an
item is, the more likely it is that you will need the help of the manufacturer or
his representative.
◆ Whether the HTM Teams have the necessary skills. For example, if your staff
cannot undertake the job it is useful to ask for assistance from a contractor.
◆ Whether you are buying one item or bulk buying. For example, if you are only
buying one item, it may not be worth the expense of getting the manufacturer’s
help and your HTM Team can manage with sufficient written guidance from
the manufacturer. But if you are buying large quantities of the same product it
will be worthwhile contracting the manufacturer to undertake the installation,
commissioning, and initial training at as many locations as necessary.
117
5.4 Support activities to enable you to use your purchases and donations
We recognize that for some equipment, installation, commissioning, and initial

training will happen all at once, will be undertaken by the same people, and can be
included in one quote. However, in the rest of this sub-section we consider the
needs for installation and commissioning separately from initial training, since
sometimes:
◆ you need installation and commissioning but no training
◆ you need initial training but minimal installation and commissioning work
◆ initial training takes place at a later date to installation and commissioning
◆ initial training is undertaken by different people than those doing the installation
and commissioning
◆ the organization of training has different requirements than installation and
commissioning.
5.4.1 Installation and Commissioning Costs
It is very important to ensure that new equipment is effectively installed and

commissioned if you want it to work correctly and safely right from the start of your
ownership. Even if the equipment is quite a common item, it is still necessary to
install and commission it well.
Tip • It is always best to address the need for installation and commissioning during the
purchase or donation negotiations.
Provision of installation and commissioning should be linked to the procurement

contract (see Guide 3 on procurement and commissioning). In other words, when
purchasing equipment from a company, you should request them to provide installation
and commissioning at the same time if you cannot undertake it yourself. Provision of
such support activities must be mentioned in your equipment specification (Section
4.5). If you are able to standardize your equipment and purchase in bulk in collaboration
with other health facilities, it is more likely that equipment suppliers will be willing to
travel to undertake this work, since they can cover several sites in one trip.
118
5.4.1 Installation and commissioning costs
People Involved
If you have the skills, installation and commissioning should be undertaken by a
combination of your HTM Team (or other teams from an appropriate level of the
HTM Service) for the technical work, and the Commissioning Team (Section 1.2)
for administrative work.
In the government system, plant may be installed and commissioned by staff from
the Ministry of Works. If you need help, you could ask for support from other bodies
such as another health service provider. However, for complex or unfamiliar items it is
recommended to ask for assistance from the supplier company or its representative.
If you are using external support, it is useful to arrange for some of your in-house
maintainers to accompany the external engineers for two reasons:
◆ to learn from watching the process
◆ to monitor that the work takes place (see Guide 5).
Requirements
Any outside contractor or organization assisting you will assume that you have made
the site ready before the date they are due to arrive (Section 5.3). They will also
expect you to provide a convenient nearby connection point on your service supply
installations (such as a suitable tap, circuit breaker or drain outlet) and will only
expect to provide materials to extend from the new equipment to this point. They
will budget for materials accordingly.
The contractors/organization will bring what are known as ‘start-up’ consumable items
with them – this is just enough to operate the equipment while checking that it is
performing correctly and safely. They will not bring stocks of operating consumables
for you to run the equipment with. You must ask for stocks of these in the
procurement contract/specification (Section 4.5).
You should provide a room for any visiting installation technician/engineer (whether
in-house or contracted staff) to use as an office, as a base to work from, and a safe
store for their materials and test equipment.
There will be a variety of other inputs required for the installation and
commissioning work (for example, accommodation, fees, travel arrangements) as
described in Figure 16.
119
Country Experiences
Examples of the kinds of problems that have arisen with installation and commissioning
in many developing countries include:
No skills: new items of equipment left rotting in their crates at health facility sites
because there was no one with the skills to install it
Poor work: new equipment arrived on site but never worked properly, due to poor
installation and commissioning procedures
Poor planning: installation engineers were assured by health facilities that the site was
ready, but arrived to find that they could not start work, because there
was not the correct electricity/water/gas supply.
Who is Responsible for Calculating Installation and Commissioning

Costs?
Preference
The HTM Working Group or its smaller Commissioning Team should be responsible for
identifying installation and commissioning needs, and negotiating with the suppliers of
equipment (see Guide 3).

HTM Working Group or its Need to learn how to budget for installation and
Commissioning Team commissioning
Any health facility or service Can make installation and commissioning
level that: calculations
budget allocations
A service level (such as Will find the calculations here for exact estimates
facility or district) that makes most useful
Any service level that Can use the calculations described here for exact
estimate installation and
commissioning needs at
the variety of sites they
purchase for.
120

central or regional/district long-term forward plans and budget allocations, and
levels) that: can use the calculations in Section 5.2.
facilities
details
How To Calculate the Installation and Commissioning Costs

You can make:
◆ either rough estimations for long-term forward planning purposes, by referring to
Boxes 23–25 (Section 5.2) and using a percentage estimate of the equipment
price to cover installation and commissioning as well as initial training (the
‘package of support inputs’)
◆ or exact estimates for specific equipment purchases, and investigate the needs for
your bulk purchases, as shown in Figure 16.
To make exact estimates, according to Figure 16, you need to know more specific
details about the site.
Tip • The service level responsible for making these calculations will have to visit the site,
or know about the site, or have access to relevant site and engineering drawings.
Figure 16: How To Make Specific Estimates of Installation and Commissioning Costs
Process Activity
The HTM Working Group or Commissioning Team:
• What arrangements for installation and commissioning have

you negotiated in the procurement contracts/donation
Identifies any arrangements made agreements?
• Is installation and commissioning the responsibility of the
supplier or yourselves?
Will it be:
• staff from the equipment manufacturer?
• staff from the manufacturer's representative?
• maintenance staff from other teams, workshops, health
facilities, ministries, or health service providers who are
Identifies who will undertake the knowledgeable about the equipment?
installation and commissioning • senior maintenance staff within your team, workshop, or health
facility who have experience of installing and commissioning
the equipment or have the necessary skills?
• partners in technical co-operation projects, or staff from
non-governmental organisations and charities?
Continued overleaf
121
Figure 16: How To Make Specific Estimates of Installation and Commissioning Costs
(continued)
In order to:
• request quotes and information on how the installation and
commissioning will be provided
Liaises with any external installers • discover any needs they have
• identify whether initial training costs will be included or extra
(see Figure 17).
Do you need:
• overnight accommodation for the installers?
• travel and subsistence for the installers (especially if from
Identifies the inputs required abroad)?
• labour costs?
• material costs for installation (such as cable, plugs, piping)?
• material costs for checking operation (consumables used
whilst ensuring equipment is performing correctly)?
Submit the total installation and commissioning costs to the

Calculates the costs
Health Management Team.
Health Management Team:
Decide which elements of the installation and commissioning

Allocates the necessary budgets costs can be covered by the capital expenditure budget and
which should be covered by recurrent budgets.
5.4.2 Initial Training Costs

It is very important to obtain some ‘initial’ training for operator and maintenance
staff on the new machines. Even if the type of equipment has been used before, staff
need to understand the operating requirements of a new make and model.
Tip • It is always best to address the need for application, operator, and maintenance
training packages during the purchase or donation negotiations.
The provision of training should be linked to the procurement contract (see Guide 3
on procurement and commissioning). In other words, when purchasing equipment
from a company, you should also ask them to provide training. Such support activities
must be mentioned in your equipment specification (Section 4.5). It is more likely
that equipment suppliers will be willing to offer training packages if your equipment
is standardized and purchased in bulk in collaboration with other health facilities.
The Needs
The cost of the training will depend upon whether you are buying single pieces of
equipment or buying in bulk. It also depends upon a number of other issues (see
Annex 2 for further guidance), as follows:
122
5.4.2 Initial training costs
Contractual Arrangements
As part of your procurement contract, you should negotiate who will pay for the
training and where it will take place. The training arrangements may be dependent
on the type and total cost of the equipment. If training is not provided by the
supplier, you can run the training sessions yourselves.
The Training Required

Training will be required for a variety of different types of staff (for example,
operators or maintenance staff), at different skill levels (such as doctors and nurses,
engineers and technicians), and will need to cover a variety of topics (such as
equipment operation, safety and maintenance).
The Trainers
The people who run the equipment training sessions can be representatives from
the equipment supplier company, or staff from your health service provider, or
another support organization. The cost of these trainers will vary, and you may have
to identify in-house staff to be trained as trainers first.
Training Sites
You must consider whether:
◆ your staff will travel to the trainer (perhaps the manufacturer’s factory, either
locally, in a neighbouring country, or abroad – which, if well organized, can be

useful for expensive equipment), or whether the trainers will come to you
◆ to repeat the training at many health facilities, or to bring the trainees to a central
location for training
◆ to bring the (portable) equipment to a suitable training room, or conduct the
training where the equipment is situated. For large items which are difficult to
move (such as operating tables, blood-bank fridge) and installed equipment
(dental suites, water still), the training sessions will have to be planned around
the equipment while trying to cause the minimum disruption to the services
provided by the department.
123
The Numbers to be Trained

Different quantities of staff will attend the training depending on the type of
equipment and the department concerned. For example:
◆ for complex equipment in the theatre, the majority of theatre staff need to attend
the training
◆ for some general equipment used on the ward, only a few representatives from
each ward need to attend, who in turn should pass on their skills to the bulk of the
ward staff
◆ technical staff should be chosen from the relevant engineering discipline (such as
electrical or mechanical), and with varying skill levels (for example, engineer,
technician, and artisan)
◆ check if other staff, such as cleaners, need special orientation
◆ for the skills to be spread among the wider workforce who did not attend, you
must ensure you run extra courses so that the trained staff can teach their
colleagues.
Inputs
There will be a variety of different administrative and material inputs required for
running training sessions (for example, accommodation, fees, handouts) as
summarized in Figure 17 and detailed in Box 33 of Section 6.4.
Who is Responsible for Calculating Initial Training Costs?

Preference
Various people can be involved in identifying training needs. We suggest that the HTM
Working Group, or a smaller training sub-group (Section 1.2) should be responsible for
developing all training needs for the overall Equipment Training Plan (Section 7.2). In
addition, we suggest the Commissioning Team should be involved in negotiations with the
suppliers for new purchases, including the training of staff (see Guide 3).

- HTM Working Group or a Need to learn how to budget for training which is
smaller training sub-group linked to purchases
- Commissioning Team
Any health facility or service Can make training calculations for purchases
level that:
budget allocations
124

Any service level that Can use the calculations described here for exact
estimate training
requirements at the variety
of sites they purchase for.
central or regional/district long-term forward plans and budget allocations, and
levels) that: can use the calculations in Section 5.2.
facilities
details
How To Calculate the Initial Training Costs linked to Purchases

You can make:
◆ either rough estimations for long-term forward planning purposes, by referring
to Boxes 23–25 (Section 5.2) and using a percentage estimate of the equipment
price to cover initial training as well as installation and commissioning (the
‘package of support inputs’)
◆ or exact estimates for specific equipment purchases, and investigate the needs
for your bulk purchases, as shown in Figure 17.
details about the staffing situation.
Tip • The service level which makes these calculations will have to know about, or
obtain information about, the staffing and training requirements at each site.
125
Figure 17: How To Make Specific Estimates of Costs for Initial Training Linked to Purchases
Process Activity
The HTM Working Group or its training sub-group:
• What arrangements for training have you negotiated in the

Identifies any arrangements made procurement contracts/donation agreements?
• Is training the responsibility of the supplier or yourselves?
Do you need training on:

• good practice when handling equipment?
• basic ‘do’s and don’ts’?
Identifies the range of training • how to operate equipment?
required • the correct application of equipment?
• care, cleaning, and decontamination?
• safety procedures?
• planned preventive maintenance (PPM) for users?
• PPM and repair for maintainers?
Which different types of staff should be taught the different skills

Identifies the trainees
described above?
Will they be:

• staff from the equipment manufacturer?
• staff from the manufacturer's representative?
• clinical or maintenance staff from other teams, workshops,
health facilities, and health service providers who are
Identifies who will be the trainers knowledgeable about the equipment?
• senior clinical or maintenance staff within your team, workshop,
or health facility who were previously trained on the equipment
or have the necessary skills?
• partners in technical cooperation projects, or staff from
non-governmental organizations and charities?
Will it be:
• at the manufacturer's factory or their local representative's
Identifies the training site workplace?
• at the health facility or a central location for training?
• in a special training room and/or around the equipment itself?
• How many staff need training at each site?

Identifies numbers to be trained
• How many times should the training sessions be run?
Do you need:
• room hire?
• overnight accommodation for the trainees or trainers?
• travel and subsistence for the trainees or trainers (especially if
Identifies the resources required from abroad)?
• trainers’ fees?
• visual aids and teaching equipment?
• training materials (handouts) for the trainees?
• consumable inputs for the equipment demonstrations?
Continued opposite
126
5.5 Large-scale major rehabilitation projects
Figure 17: How To Make Specific Estimates of Costs for Initial Training Linked to Purchases
(continued)
In order to:
• notify any suppliers involved of the types of training required
Liaises with the Commissioning • request quotes and information on how the training will be
Team provided
• identify whether the training will be part of the installation and
commissioning costs (see Figure 16) or extra.
Submit the total training costs linked to purchases to the

Calculates the costs
Health Management Team.
Decide which elements of the training costs can be covered

Allocates the necessary budgets by the capital expenditure budget and which should be covered
by recurrent budgets.
5.5 LARGE-SCALE MAJOR REHABILITATION

PROJECTS
You may have parts of your facility or pieces of equipment which have not been
functioning for a while, which you would like to bring back into working condition.
Such a task would involve more work and more inputs than a simple repair and, as
such, would require a specific rehabilitation (renovation) project. If such a job is
cheaper than replacing the broken items with new ones, then funds are required so
that you can get more of your stock working again.
Large-scale equipment rehabilitation projects may be too expensive to come out of

annual maintenance recurrent allocations, due to the amount of materials or size of
contracts required. These will have to be financed from the capital budget.
127
Who is Responsible for Calculating Rehabilitation Costs?

HTM Managers with Need to learn how to cost large-scale major
technical skills (those rehabilitation projects for equipment
located at maintenance
workshops – Section 1.1)
Any health facility or service Can make calculations for rehabilitation work
level that:
budget allocations
- specific projects
Any service level that Can use the calculations described for exact
undertakes many estimates
rehabilitation projects and
estimate requirements at the
variety of sites they cover.
Service levels (such as Only need to make the rough estimations
central or regional/district described here for their long-term forward plans and
levels) that: budget allocations
facilities
details.
How To Calculate the Cost of Major Rehabilitation Work

You can make:
◆ either rough estimations for long-term forward planning purposes, as shown in
Box 27
◆ or exact estimates for specific rehabilitation projects, and investigate the needs
for a number of projects at various sites, as shown in Figure 18.
It is difficult to make global rough estimates for the cost of major rehabilitation
projects. However, Box 27 provides some suggestions from various countries.
128
BOX 27: Suggestions for Rough Estimations of Large-scale Major Rehabilitation Costs for
Forward Planning
Different countries suggest alternative approaches to determine whether it is worth carrying out the
rehabilitation work:
i. The cost will depend upon the present status and condition of the equipment.
In order for rehabilitation work to be worthwhile, it must add an extra five years to the life of the equipment.
ii. The cost of rehabilitation obviously must be less than the price of replacing the equipment.
Some countries do not recommend continuing with rehabilitation if the cost will be more than 50 per
cent of the new equipment value.
Consider what is the maximum percentage of equipment value that you could spend that still makes the
rehabilitation worthwhile (ask your health economist, accountants, or finance officer).
iii. If you bought separately all the parts that made up a piece of equipment, it would cost you three to four
times the price of the equipment.
Therefore if five to ten per cent of the equipment parts need replacing, you would have to budget for at
least one-third of the new equipment value to buy the parts for the rehabilitation project.
Calculate the cost of the spare parts that you anticipate you will need and, if this is too large a proportion
of the new equipment value, then consider replacing the equipment rather than rehabilitating it.
details about the site.
Tip • The service level responsible for making these calculations will have to visit the
site, or must have sufficient knowledge or information about the equipment and
site to make informed calculations.
129
Figure 18: How To Make Specific Estimates of Large-scale Major Rehabilitation Project Costs
Process Activity
HTM Managers at Workshops, and their Teams:
Identify any major rehabilitation projects agreed in the

Identify the needs Equipment Development Plan (Section 7.1) or the Annual
Rehabilitation Activities (Section 8.1).
Using the process described in Figure 15 (for pre-installation

work), detail the work required for:
• construction or building alterations
• removal of existing equipment
Determine the work required • electrical requirements
• water and drainage
• steam supply
• gas supply
• other equipment-specific requirements
• additional associated equipment needs
Evaluate:
• the spare parts and maintenance materials required to
Identify the inputs required undertake the planned rehabilitation activities.
• the requirements for work to be undertaken by sub-contractors
for the planned rehabilitation activities.
Prepare detailed costs of the work required (including the

Cost the needs contracts).
The Health Management Team or Finance Officer:
Establish:
• which elements of the rehabilitation projects are too expensive
Identifies the sources of funds to fall under the annual maintenance budget and must be
covered by the capital expenditure budget.
• whether there is assistance available from external support
agencies.
Provides the finances Allocate sufficient funds from the budgets to cover such major
equipment rehabilitation projects.
130
Section 5 summary
Once you have learnt how to undertake these capital budget calculations, as
described in this Section, you can use them to make your long-term Core
Equipment Expenditure Plan (Section 7.3) and to undertake annual budgeting
(Section 8.1). An example of a total capital budget plan is given in Section 7.3.
BOX 28: Summary of Procedures in Section 5 on Capital Budget Calculations
HTM Working make rough estimations of replacement costs for long-term forward plans and budget
Purchases Replace
◆
Groups and allocations, by using a percentage of the equipment stock value (see Figure 14)
Finance Officers ◆ make exact estimates of replacement costs, by using detailed calculations for
purchases as described below (see Boxes 24–26)
HTM Working ◆ make rough estimations of equipment purchase costs for forward planning and bulk
Groups, and purchasing, by using a percentage of the equipment price (see Box 23)
Purchasing and ◆ make detailed estimates for single purchases and annual needs, by considering the
Supplies Officers sophistication of the equipment and using a percentage of its price (see Boxes 24–26)
HTM Working ◆ makes rough estimations of pre-installation costs for forward planning and budget
Support Activities Pre-install
Group, or its allocations, by considering the suggestions relating to equipment weight, size,
Commissioning portability, technology type, and price (see Boxes 25 and 26)
Team ◆ makes detailed estimates for pre-installation work for single purchases, bulk
purchases, and annual needs, by costing specific requirements (see Figure 15)
HTM Working ◆ makes rough estimations for installation, commissioning, and initial training costs
Group, or its for forward planning and budget allocations, by using a percentage of the
Commissioning equipment price (see Boxes 23–25)
Team ◆ makes detailed estimates for installation and commissioning costs for single
purchases, bulk purchases, and annual needs, by costing specific requirements (see
Figure 16)
◆ makes detailed estimates for initial training costs for single purchases, bulk
purchases, and annual needs, by costing specific requirements (see Figure 17)
HTM Managers ◆ make rough estimations for costs of large-scale major rehabilitation projects for
at Workshops forward planning and budget allocations, by considering the suggestions relating to a
Rehab
percentage of the equipment price (see Box 27)

◆ make detailed estimates for costs of large-scale rehabilitation work for single
projects, multiple projects, and annual needs, by costing specific requirements (see
Figure 18).
131
132
6. How to make recurrent budget calculations – budgeting tools II
6. HOW TO MAKE RECURRENT BUDGET

CALCULATIONS – BUDGETING TOOLS II

Recurrent funds are required to cover regular expenses which are necessary
to keep equipment functioning and running. Such expenses could include
buying consumables, maintenance support, training, or stationery required for
record-keeping. These requirements can be planned for on a weekly, monthly,
or annual basis.
If you do not allocate sufficient funds for these expenses, you may not have
sufficient equipment that works, or you may wait for months before new items
can be utilized.
This Section provides advice on how you can learn to budget for all these costs.
Although the planning tools (Sections 3 and 4) will help you to identify what
equipment you want, you should only own those items that you can afford to keep
functioning. This is determined by budgeting for equipment running costs according
to the principles and budget calculations outlined in this Section.
This Section describes some further ‘budgeting tools’, which can help you to
understand how to make various calculations for recurrent costs. Different
calculations are described for the different health service levels. You can then use
these calculations when making your plans and budgets, as described in Sections 7
and 8.1.
As Section 3.3 explains, recurrent expenditure is required each year to enable you to
keep your equipment going. You should calculate your recurrent expenditure
allocations based on your existing stock of equipment. Please remember that
whenever new equipment is purchased (Section 5.2), it is necessary to budget for
its running costs. Therefore, there must be a link between planned capital
expenditure and recurrent budget allocations.
In order to make adequate allocations, you need further budgeting tools. This
Section covers four budget calculations for recurrent allocations:
◆ maintenance costs (Section 6.1)
◆ consumable operating costs (Section 6.2)

◆ administrative costs (Section 6.3)
◆ ongoing training costs (Section 6.4).
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6. How to make recurrent budget calculations – budgeting tools II
In this Section, different ways of calculating recurrent budget elements are given.
They are used for different purposes, as follows:
a. Rough Estimations – used for long-term plans and business purposes

– most often used at central or regional levels
which cover the needs of many facilities and
cannot go into specific details.
b. Exact Detailed Estimates – used for annual requirements
– most often used at facility or district level.
It is important to remember that in many developing countries:

◆ equipment capital projects, often funded by external support agencies, can
introduce considerable recurrent budget burdens

◆ many donors are hesitant to assist with recurrent costs and leave the recipient
country to cope, even if they are not in a financial position to do so
◆ some donors provide maintenance contracts for a couple of years with the
equipment, but do not usually offer more sustainable solutions.
For these reasons, experts in this field are calling upon the donor community to show
more commitment by:
◆ assisting countries to develop adequate HTM systems
◆ contributing to recurrent expenditures for maintenance via a suitable national body

◆ setting aside 30 per cent of available project financing for recurrent needs.
6.1 MAINTENANCE COSTS

Equipment can only be used at its optimum performance level if it is regularly
maintained. Therefore it is necessary to plan for the annual cost of maintenance
and repair for the equipment stock, which will include any minor rehabilitation
work required.
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6.1 Maintenance costs
Some of this Section may appear similar to the discussion regarding consumable
operating costs (Section 6.2). The key difference is that the calculations described
here are usually made by maintenance staff, or planners.
The objective of drawing up maintenance budgets is to estimate the money

required to maintain and repair the equipment, and thus ensure that the equipment
remains functional for as much of the year as possible. This is known as reducing the
‘mean-time between failures’ (MTBF). It is important to make an estimate which is
as realistic as possible, since:
◆ under-estimation will result in unsatisfactory maintenance for that year
◆ over-estimation will deprive other essential services in the facility of their

necessary resources.
For long-term planning, international experts provide estimates of the amount which
should be set aside each year. These amounts are expressed as a percentage of the
stock value (Section 3.2). These estimates are based on an average, so some equipment
in your stock will require much less money and some will require much more (the
precise amount required will depend on the equipment type and age). Experts
suggest that maintenance and repair costs ought to be approximately as follows:
◆ for medical equipment, each year five to six per cent of the ‘new’ stock value is
required
◆ for buildings, each year one to two per cent of the construction costs is required
◆ for service supplies and plant, each year three to four per cent of purchase and
installation costs is required.
Country Experience
Although the experts suggest five to six per cent of the new medical equipment stock
value each year for maintenance, countries have found different estimates work better for
them, depending on local conditions. For example:
◆ In East Africa, HTM managers found a budget of six to ten per cent of the medical
equipment stock value was more useful for covering maintenance needs and spare
parts, depending on local labour costs.
◆ In Sri Lanka, the Ministry of Health found the budget required for maintenance varied
with the age of equipment, as follows:
- one to four years old two to three per cent of stock value is needed
- five to six years old four to six per cent of stock value is needed
- seven to ten years old seven to eight per cent of stock value is needed.
135
Nevertheless, it is common for countries to have maintenance budgets as low as, or

even less than, one per cent of the equipment stock value, making it impossible to
keep the equipment functioning or safe. Also because maintenance funding over
many years has been generally so low, maintenance staff have automatically self-
limited their estimates and disregarded the need to return many items of equipment
stock to a working condition.
Country Experience
◆ Many health service providers have not calculated their equipment stock values, and
therefore they do not know what finances are required to sustain their stock.
◆ Many health service providers measure maintenance budgets as a percentage of the
health budget allocation (to a facility), rather than as a percentage of the equipment
stock value.
◆ Some countries are introducing new initiatives to try to increase maintenance
allocations by requiring health facilities to put aside a certain amount for maintenance.
For example:
- the Central Board of Health in Zambia requires hospital boards (semi-autonomous
facilities) to use 10 per cent of their recurrent budget allocations (net of salaries)
for maintenance
- the Ministry of Health in Kenya requires autonomous health facilities to use 25 per
cent of their generated income for maintenance.
◆ Such directives are welcomed, and are a step forward. However there is a danger that
they can be misleading, since the percentage allocated does not relate to the
equipment stock value and is not a measure of the well-being of the equipment.
For example:
- in the Zambian example given above, at the central teaching hospital the 10 per cent
directive translates into a figure that is only approximately 1.6 per cent of the
equipment stock value estimate.
◆ Other initiatives are being tried. For example:
- the Ministry of Works, Transport, and Communication in Namibia is selling off
government fixed property which is not in government use, and residential properties
(not in remote locations). The money raised will be invested to generate funds for
general maintenance of the remaining government facilities, and for building staff
housing in remote areas.
As a start, you will need to allocate at least some percentage of the equipment stock
value as your maintenance budget, if your situation is to start to improve. However,
you may have a large backlog of equipment waiting to be repaired. If so, this will have
a knock-on effect on your maintenance budgets, since the real value of annual
maintenance requirements will be much greater than your current planned
maintenance budget levels.
136
Maintenance costs are more than compensated by the gains obtained from extending
the useful life of equipment (Guides 1 and 5 provide examples as proof). Once you
have overcome any backlog of equipment that is waiting to be repaired, you should
ultimately find that maintenance will not generate costs, but save you money.
In some industrialized countries, there are laws in place which regulate that planned
preventive maintenance (PPM) must take place in order to ensure that equipment is
safe (see Guide 1). This is useful, as it means that funds for PPM must be allocated
by health service providers.
It is likely you will have a great deal of equipment within your facility which is very
old. Some of this equipment may be past the end of its lifetime and awaiting
replacement. Other items may be waiting to be repaired. However, it must be
recognized that it might be uneconomical to continue to try to repair such
equipment. Figure 19 illustrates how the cost of maintenance rises as equipment
gets older.
Figure 19: Traditional ‘Bath-tub’ Curve of Maintenance Costs over the Lifetime of Equipment
Maintenance
costs
installation
& settling in useful life old age
Time (years)
If a large proportion of your equipment is past rehabilitation, it may be necessary to

make maintenance calculations based on a smaller proportion of the stock which you
can keep working, while increasing the replacement budget (Section 5.1). The
longer you leave it to improve maintenance services, the greater your equipment
replacement bill will be.
137
Who is Responsible for Calculating Maintenance Costs?

- HTM Managers with Need to learn how to budget for maintenance costs
technical skills
- HTM Working Groups
- Finance Officers
Any health facility, workshop, Can make maintenance calculations
or service level that:
budget allocations
levels that: long-term forward plans and budget allocations, and
- cover the needs of many business plans
facilities
details.
Facility, workshop, or district Are more likely to make more exact detailed
service levels estimates for annual requirements.
How to Calculate Maintenance Costs

You can:
a. make rough estimations
b. make specific or annual estimates
c. determine monthly estimates within the annual allocation.
These three different approaches to calculating maintenance costs are described in

greater detail below.
a. Making Rough Estimations of Maintenance Costs

You can make a variety of rough estimations for long-term plans, depending on:
◆ the information available to you (refer to your Maintenance Management
Information System, such as your equipment service histories – see Guide 5)

◆ the sort of forward projections you are making
◆ how much of your equipment stock it is possible to return to a working condition,
and how much you can afford to rehabilitate.
Figure 20 describes these calculations.
138
Figure 20: How To Make Rough Estimations of Maintenance Costs for Forward Planning
Process Activity
HTM Working Groups and/or HTM Managers:
Use the up-to-date

equipment stock values and
Refer to existing documents
equipment reference price
lists (Section 3.2)
Use one of the following

Calculate adequate methods depending on the
maintenance budget type of financial projections
requirements you require in your
(business) plan:
Cost the Model Equipment List (Section 4.3)

for your type of facility.
Then calculate:
• 5-6 per cent of the ideal stock value for
medical equipment, for its maintenance
If you want an ideal each year;
estimate for your • 1-2 per cent of the ideal construction
type of facility costs for buildings, for their maintenance
each year;
• 3-4 per cent of the ideal purchase and
installation costs for service supplies and
plant, for their maintenance each year.
Cost the existing Equipment Inventory

(Section 3.1) for your facility.
Then calculate:
• 5-6 per cent of the realistic stock value for
If you want a more medical equipment, for its maintenance
realistic estimate each year;
based on your • 1-2 per cent of the realistic construction
current stock costs for buildings, for their maintenance
each year;
• 3-4 per cent of the realistic purchase and
Cost the existing Equipment Inventory.

Then calculate:
• the percentage which is actually
repairable (for example, 20 per cent) to
obtain the value of the reduced stock of
items which are worth rehabilitating.
If you want a Then calculate:
reduced estimate • 5-6 per cent of the reduced stock value
based on the current for medical equipment, for its
stock it is possible maintenance each year;
for you to rehabilitate • 1-2 per cent of the reduced construction
costs for buildings, for their maintenance
each year;
• 3-4 per cent of the reduced purchase and
Continued overleaf
139
Figure 20: How To Make Rough Estimations of Maintenance Costs for Forward Planning
(continued)
Identify and cost only certain equipment

areas to concentrate on, which you want to
keep functioning over the next few years.
Then calculate:
• 5-6 per cent of the pragmatic stock value
If you want a more for medical equipment, for its
pragmatic/practical maintenance each year;
estimate for your • 1-2 per cent of the pragmatic construction
most urgent needs costs for buildings, for their maintenance
each year;
• 3-4 per cent of the pragmatic purchase
and installation costs for service supplies
and plant, for their maintenance each
year.
Feed back the maintenance Were reduced or pragmatic If so, increase the replacement budget so
assumptions made here, to maintenance amounts that more of the facility's stock can be
the replacement budget calculated? (See last two returned to a working and repairable
calculations methods shown above) condition (see Figure 14 in Section 5.1).
b. Making Specific or Annual Estimates of Maintenance Costs

A different calculation is required when making specific or annual estimates. It
should be undertaken by HTM Managers with technical skills (such as those located
at a maintenance workshop – Section 1.1).
Annual maintenance budgets should be based on more exact estimates. They are
not always easy to predict, since breakdowns in most cases cannot be anticipated.
However, two types of budgeting can be identified (see Box 29, below). Generally
with experience, and where standardization of equipment is in place (Section 2.1),
the projection for equipment spare parts and maintenance materials becomes more
predictable.
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BOX 29: Elements of Annual Maintenance Budgets
I. Planned Budgets:
These allocate funds for anticipated maintenance costs, which can be derived from the following main areas
of expenditure (see Figure 21 for strategies on how to calculate your requirements):
a) spare parts – which are required regularly, determined from previous experience and any planned
remedial work
b) spare parts – which are required according to planned preventive maintenance (PPM) schedules
and timetables
c) maintenance materials – which are required regularly, determined by previous experience and any
planned remedial work
d) maintenance materials – which are required according to PPM schedules and timetables
e) service contracts – required for any planned remedial work
f) service contracts – for breakdowns which are likely to be required, determined from previous experience
g) service contracts – required for PPM of complex equipment
h) calibration of workshop test equipment
i) replacement of tools at the end of their life
j) office material
k) any increased maintenance requirements brought about by planned new equipment purchases under the
capital expenditure budget.
Note: there will be other elements which may fall under other budgets. These could include:
◆ other administrative costs which are included in budgets held by other departments (Section 6.3)
◆ major repair works – in some cases the planned rehabilitation of equipment which requires major work
with the purchase of substantial amounts of materials or contracts. The large sums of money required for
such projects may have to fall under the capital budget (Section 5.5)
◆ pre-installation work (such as site-preparation). This often falls under capital funds as it is linked to
specific purchases (Section 5.3).
II. Contingency Budgets:

In addition to planned budgets, contingency budgets also exist. These allocate funds for unplanned
maintenance work, such as emergencies, or sudden breakdowns which could not be predicted.
Tip • When planning for spare parts and maintenance materials, it makes sense to:
- budget well in advance so that you have sufficient funds and do not run out of stocks
- buy in bulk so that you can make procurement savings
- only procure essential spares
- for perishable items, only buy quantities that you can use up before their shelf-life
expires.
141
No spare parts should be allowed to sit on shelves for too long as this ties up money
which could otherwise be used for other essential purchases. The only exception to
this is when buying equipment from abroad, when it makes sense to buy a stock of
spare parts at the same time as the equipment, because that is when the capital
funds are available, and you are in contact with the manufacturer (Section 5.2). If
you leave it until later, it becomes much more difficult to obtain the funding, the
foreign currency, and the spare parts from abroad. Details of how to stock up with
spare parts and maintenance materials are given in Guide 5.
Having purchased your initial stock with the equipment (Section 5.2), you must
review your recurrent stock needs. It is important to consider ‘economies of scales’ –
for example, you can get better prices and save on shipping costs if you buy in bulk.
Therefore it is a good idea to consider:
◆ buying for many locations (for example, to cover several health facilities
or workshops)
◆ buying stocks to cover an extended period (for example, stocks for one or two years).
Previously, equipment spare parts and maintenance materials have not always been
considered ‘stockable’ items in the Stores system. For this reason, there is often
insufficient information regarding their requirements and rates of use. Thus one of
your planning tools is an exercise to investigate their needs (Section 3.4).
Figure 21 shows the exact estimates you can make for specific or annual
requirements.
Figure 21: How to Make Specific or Annual Estimates of Maintenance Costs
Process Activity
HTM Managers at Workshops, and their Teams:
Using Box 29, consider the ‘Planned Budgets’ elements a – d.

For each different type of equipment, list the essential spare
parts and maintenance materials, using as guides:
• the Planned Preventative Maintenance (PPM) schedules and
timetables (see Guide 5)
Evaluate essential spare parts and • planned remedial work (such as actions in the ‘Annual
maintenance materials required Rehabilitation Activities’ and ‘Annual Corrective Activities’ –
see Section 8.1)
• experience of typical problems, the parts typically used, and
the parts which typically run out (see planning tool exercise in
Section 3.4 for guidance)
• an allowance for any emergencies.
Cost the spare parts and Price the list of spare parts and maintenance materials for each
maintenance materials identified type of equipment (see above). Multiply the sum by the total
above numbers of each equipment type involved.
Continued opposite
142
Figure 21: How to Make Specific or Annual Estimates of Maintenance Costs (continued)
Using Box 29, consider the ‘Planned Budgets’ elements
e – g. List the requirements for maintenance contracts for
equipment, using as guides:
Evaluate maintenance contracts • those contracts which have already been drawn up
required for equipment • experience of typical contracts which are likely to be required
• planned remedial work (such as actions in the ‘Annual
Rehabilitation Activities’ and ‘Annual Corrective Activities’ –
see Section 8.1)
Cost the maintenance contracts Estimate the total cost of the various maintenance contracts
identified above identified above.
Using Box 29, consider the ‘Planned Budgets’ elements h – j,

Cost the care and repair of and estimate the cost of:
workshop test and measuring • calibrating and servicing workshop test and measuring
instruments, and tools; also cost instruments, and tools
the office materials • replacing old tools
• materials (stationery, ink, toner, etc) for running the office.
For ‘Planned Budgets’ element k (in Box 29), liaise with the
Identify any planned new Purchasing and Supplies Officer to identify any planned new
equipment purchases equipment purchases under the ‘Annual Purchase Activities’
(Section 8.1), which have been approved by the Tender
Committee for procurement from the capital expenditure budget.
Cost the maintenance needs for Estimate the cost of the additional maintenance requirements
new items identified above for new items (from above).
Activity
Review the total range of costs that have been estimated (from
all of the above), and:
Review and prioritize all of the • identify any major rehabilitation projects which will need to fall
costs estimated above under the capital expenditure budget (Section 5.5), and agree
this with the HTM Working Group;
• prioritize across the rest of the needs in order to come up with
a consolidated annual maintenance estimate.
If the annual estimate is too big to be covered:

Adjust the figures if you are short
• ensure that a regular budget is set
of money
• prioritize which work will be done.
Liaise with other budget holders (Section 6.3), and ensure that
Ensure other budgets are set sufficient estimates are placed in the administration budget to
which affect maintenance services cover the requirements of the maintenance service
(see Figure 23).
143
c. Determining Monthly Maintenance Estimates within the Annual

Allocation
Within the annual maintenance allocation, the HTM Manager will have to
determine monthly requirements. As a rough estimate, the HTM Manager could
consider the monthly maintenance budget to be one-twelfth of the annual
maintenance allocation. However there may be seasonal variations which need to be
taken into account, for example workload may be heavier at certain times of the year
or weather conditions could affect the ability of equipment to function.
A more specific monthly maintenance budget can be derived from a combination of

the cost for both the planned preventive maintenance (PPM) work and the planned
remedial/repair work identified for that month. This would involve carrying out an
estimate of maintenance costs (using the process outlined in Figure 21) on a
monthly basis. If insufficient financial resources are available, the HTM Manager
will have to prioritize what work should be carried out.
Please note: In Section 6.1, we have only covered the general planning and
budgeting of maintenance work. For a more a detailed explanation of the daily
financial management required by HTM Teams, see Guide 6.
When undertaking planning and budgeting work, the HTM Teams will need to be
sure of their financial responsibility and financial accountability as they undertake
maintenance work, undertake other equipment management tasks, and run a
workshop. Guide 6 also discusses the possibility of charging for HTM Services.
6.2 CONSUMABLE OPERATING COSTS

Equipment can only be used daily if there are regular supplies of the accessories
and consumables it uses when working. Therefore, it is necessary to plan for the
annual cost of the consumable items required for operating the equipment stock.
144
6.2 Consumable operating costs
Some of the information in this Section may appear similar to the earlier discussion
regarding maintenance costs (Section 6.1). However, the key difference is that the
calculations described here are usually made by equipment operators, or planners.
You will need to estimate the money required to cover the accessories and
consumables used by the equipment, in order to ensure that equipment continues to
function for as much of the year as possible. It is important that the estimate should
be as realistic as possible, since:
◆ under-estimation will result in periods when the equipment cannot be used
during the year

◆ over-estimation will deprive other essential services in the facility of their
necessary resources.
For long-term planning, international experts acknowledge that the percentage of the
equipment stock value required each year for consumable items can vary widely:
◆ some equipment requires a great deal for consumable operating costs (10–20 per
cent of the equipment stock value), others require none
◆ the more sophisticated the equipment, the higher the consumable operating costs
– therefore the costs will vary according to the health service level
◆ depending on your inventory, if you estimate on a large scale the consumable
operating cost will average each year to 10 per cent of the equipment stock value.
Nevertheless, it is common for countries to have recurrent budgets for equipment

consumable items which are far too small. This makes it impossible to keep the
equipment functioning. In fact, many countries do not keep track of equipment
consumables as a separate budget element at all. As a result, it is impossible to
distinguish between expenditure on these items, and other general supplies (such as
food and blankets) and medical supplies (such as bandages and gauze). This causes
them to run out of essential items such as electrodes, ultrasound gel, batteries,
washing powder, paper, reagents, gas, spare patient leads, filters and developer.
Since accessories are often the link between the machine and the patient, they are
more vulnerable to daily wear and tear, and thus need to be replaced much more
frequently than the machine itself. It must be remembered that stocks of
consumables (especially single-use items) and accessories can be very expensive.
145
Country Experience
Planners often fail to realize that equipment operating costs can have a much greater
financial impact than the initial procurement cost, and can be anything from 5% to 100%
of the procurement cost per year. For example, health staff in Germany discovered that
an infusion pump which cost US$3,000 to buy, cost an additional US$24,000 to run over
its 10-year lifetime, mainly due to the cost of the continuous supply of infusion sets
required. However, many health service providers have not calculated and budgeted for
the real operating requirements of their equipment.
The lifetime of consumables and accessories will vary for different users depending
on a number of factors, such as:
◆ the rate of use of the equipment (how many tests per month, how many patients
per year, etc.)

◆ how many back-up accessories there are (for example, is an accessory used to its
limit? Is it overworked or overloaded? While one accessory is being sterilized or
repaired, is another one available for use?)
◆ how the accessory is handled or whether it is abused
◆ how well the accessory is cared for and cleaned, and what sterilizing techniques
are used
◆ how well the equipment is maintained and whether it is running efficiently or
using up too many consumable inputs
◆ the initial quality of the equipment, and its consumable items
◆ whether staff are knowledgeable about the items, or use them wastefully
◆ the physical environment and climate in which the items are used and stored.
The cost of consumable items will also vary, depending on where you buy them from
and their quality (see Guide 3 on procurement and commissioning).
146
Experience in Ghana
The Ministry of Health distinguishes between two different types of consumable items:
◆ Common types of consumable items which can be supplied from many different
sources are handled by stores and supplies departments.
◆ More specialized items which can only be supplied by specific equipment
manufacturers are handled by their equipment managers. These can be both ‘user
consumables’ needed to operate the equipment, and ‘technical consumables’
needed for PPM.
The Ministry of Health endeavours to:
◆ purchase an initial stock of these specialized items when buying new equipment, to
last a number of years (depending on their shelf-life)
◆ establish channels with the manufacturer for subsequent purchases.
Where equipment accessories are directly connected to patients, the Ministry of Health
always purchases a stock of additional items.
Who is Responsible for Calculating Consumable Operating Costs?

- HTM Working Groups Need to learn how to budget for consumable
- Heads of Department operating costs
- Finance Officers
Any health facility service Can make consumable operating calculations
level that:
budget allocations
- cover the needs of many business plans.
facilities
details.
Facility or district service Are more likely to make more exact detailed
levels estimates for annual requirements.
147
How to Calculate Consumable Operating Costs

You can:
a. make rough estimations
b. make specific or annual estimates
c. determine monthly estimates within the annual allocation as follows:
a. Making Rough Estimations of Consumable Operating Costs

You can make a variety of rough estimations for long-term plans, depending on:
◆ the information available to you (refer to the Health Management Information
System – see Guide 1, for details such as your patient attendance statistics)
◆ the type of forward projections you are making
◆ how much of your equipment stock it is possible to keep functioning, and how
much you can afford to finance.
It is difficult to make global rough estimations of consumable operating costs as a

percentage of equipment stock values. However, Box 30 provides some suggestions
from various countries.
BOX 30: Suggestions for Rough Estimations of Consumable Operating Costs for
Forward Planning
Different countries suggest a number of alternative approaches:

i. Consumption depends on the type of equipment you use, the service you provide, and how many
patients you see.
Therefore, you can provide a rough estimation of consumable operating costs by evaluating past usage
rates/expenditures, and comparing these with expected patient loads and specific equipment usage rates
per intervention.
ii. If your equipment is part of a ‘closed’ purchasing system, the consumables are only made by one
manufacturer and you are limited to one supplier. This monopoly makes the consumable costs larger.
If your equipment is part of an ‘open’ purchasing system, anyone can supply the consumables and
different manufacturers’ consumables can fit your machine. This competition makes the consumable
costs lower.
You can keep costs down if you use items which can be sterilized/reused rather than disposable items
(see Guide 4).
iii. Consumable operating costs vary according to equipment type, and can be expressed as a percentage of
purchase cost or stock value, as shown by the examples opposite.
But as the majority of your equipment is likely to be technology that has low to medium consumable
costs, you could use averages of:
- three per cent of the stock value for equipment with low consumable usage rates, and
Continued opposite
148
BOX 30: Suggestions for Rough Estimations of Consumable Operating Costs for
Forward Planning (continued)
Description Consumable cost per year

relative to original purchase cost
Equipment with high consumable operating costs,

such as:
Haemodialysis machine
Automatic biochemical analyser
Automatic haematology analyser 70–120 per cent
Electrolyte analyser
Blood gas analyser
Equipment with medium consumable operating costs,

such as:
Conventional X-ray machine 30 per cent
Anaesthesia machine 20 per cent
ECG recorder, three channel

Ultrasound, medical/obstetric
Ventilator, ICU 15–25 per cent
Physiological monitor
EEG machine
Autoclave, steam 10–15 per cent
Incubator, baby, ICU 5–15 per cent
Equipment with low consumable operating costs,

such as:
Centrifuge, electrical 5 per cent
Suction pump 2–5 per cent
Delivery bed
Operating theatre lamp
Slit lamp 1–2 per cent
Operating microscope
Water bath
b. Making Specific or Annual Estimates of Consumable Operating Costs

A different calculation is required when making specific or annual estimates.
It should be undertaken by Heads of Equipment User Departments.
149
Annual operating budgets should be based on more exact estimates. These are not
always easy to predict since epidemics, outbreaks, or surges in workload cannot, in
most cases, be anticipated. However, two types of budgeting can be identified.
These are:
◆ planned budgets for anticipated work
◆ contingency budgets for unplanned work.
Generally with experience, and where standardization of equipment is in place

(Section 2.1), the projection for equipment consumables and spare accessories
becomes more predictable.
Tip • When planning for accessories and consumables, it makes sense to:
– budget well in advance so that you have sufficient funds and do not run out of stocks
– buy in bulk so that you can make procurement savings
– only procure essential items
– for perishable items, only buy quantities that you can use up before their
shelf-life expires.
No consumable items or spare accessories should be allowed to sit on shelves for too
long, as this ties up money which could otherwise be used for other essential
purchases. The only exception to this rule comes when buying equipment from
abroad, when it makes sense to buy a stock of accessories and consumables at the
same time as the equipment, while capital funds are available, and you are in contact
with the manufacturer (Section 5.2). If you leave it until later, it becomes much
more difficult to obtain the funding and the items. Details of how to stock up with
consumables and accessories are given in Guide 4 on operation and safety.
After the initial stock has been purchased with the equipment (Section 5.2), then
you must regularly buy your recurrent needs. It is important to consider ‘economies
of scale’ – you can get better prices and save on shipping costs if you buy in bulk. It
is therefore a good idea to consider:
◆ buying for many locations (for example to cover several health facilities)
◆ buying stocks to cover an extended period (for example, stocks for one or two years).
Equipment accessories and consumables have not necessarily been ‘stockable’ items
in the Stores system up to now, so there is often insufficient information regarding
the requirements and rates of use. So use the planning tool exercise in Section 3.4
to investigate your equipment accessory and consumable requirements.
requirements.
Box 31 provides some examples of how specific consumable operating costs can be
calculated.
150
Figure 22: How to Make Specific or Annual Estimates of Consumable Operating Costs
Process Activity
Heads of Department, with their teams:
For each different type of equipment, list the consumables and

spare accessories required to operate the equipment in your
department, using as guides:-
• experience of typical requirements for expected workloads,
departmental patient statistics, data gathered regarding
departmental requirements and rates of use (see planning tool
exercise in Section 3.4 for guidance);
Evaluate essential consumables • any new requirements for items being brought back into a
and spare accessories required working condition (as agreed in the ‘Annual Rehabilitation
Activities’ and ‘Annual Corrective Activities’– see Section 8.1);
• any additional requirements for planned new purchases of
equipment from the ‘Annual Purchase Activities’ (Section 8.1)
in the capital expenditure budget;
• the user planned preventative maintenance schedules and
timetables (see Guides 4 and 5);
Price the list of consumables and spare accessories for each

Cost the consumables and spare type of equipment (from above), and multiply the sum by the
accessories identified above total numbers of each equipment type involved.
Review the total range of costs that have been estimated (from
Review and prioritize the costs above), and:
estimated above • prioritize the needs in order to come up with a consolidated
annual estimate of consumable operating needs.
Adjust the figures if you are short If the annual estimate is too big to be covered:
of money • ensure that a regular budget is set.
Liaise with other budget holders (Section 6.3), and ensure that
Ensure other budgets are set
sufficient estimates are placed in the administration budget to
which affect equipment operation
cover the requirements of your department (see Figure 23).
BOX 31: Examples of Calculations for Consumable Operating Costs
Example 1: An electrocardiograph (ECG) recorder

Description Rate of use Units needed Costs per set/unit Costs per year
(average) per year (US$) (US$)
Recording paper one roll of paper 52 23.00 per roll 1,196
per week
Electrodes (single one set per day 365 10.00 per set 3,650
use, set)
Electrodes (reusable two sets per year 2 70.00 per set 140
type, set)
Total per year = US$4,986
Continued overleaf
151
BOX 31: Examples of Calculations for Consumable Operating Costs (continued)
Example 2: A conventional X-ray machine:

Description Rate of use Units needed Costs per set/unit Costs per year
(average) per year (US$) (US$)
Cassettes and Set of five Each year replace 3,400.00 per set 680
screens different sizes of one fifth of the
cassette and five set (in other
different sizes of words, two items
screen (i.e. two out of a set of
items per size). 10).
Replace this set of
10 items every five
years.
Films 50 films per day 18,250 1.40 per film 25,550
Reagents five litres of 60 litres 2.70 per litre 162

developer per and
month and five
60 litres 1.70 per litre 102
litres of fixing
agent per month
Total per year = US$26,494
Tip • When ordering consumable items, the lead-times (delivery times) can introduce
delays (see Guide 4), so staff may order larger quantities to avoid shortages.
c. Determining Monthly Consumable Estimates within the Annual

Allocation
Within the annual departmental allocation, the Heads of Department will have to
determine monthly requirements. As a rough estimate, they could consider the
monthly departmental budget for equipment-related consumables to be one-twelfth
of the annual allocation. However, there may be seasonal variations which need to be
taken into account, due to factors such as workload or weather conditions.
To calculate a more specific monthly departmental budget for equipment-related

consumables, you can work out a combination of the cost for the likely work for
each month, using a process similar to that described in Figure 22. The Head of
Department will have to prioritize what equipment-related consumables to order
if the required financial resources are not available.
Tip • The time between orders (frequency of ordering/supply period), will dictate
whether you can place orders every month (see Guide 4).
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6.3 Administrative costs
6.3 ADMINISTRATIVE COSTS

There are several important elements of equipment operation and maintenance
which are classified as ‘administrative costs’, and fall under budgets that are not
under the control of the equipment operators and maintenance staff. If you do not
make sure that they are adequately financed, your equipment service can fail for
want of simple things like paper, a phone connection or fuel allocations.
The calculations described here are usually carried out by various staff members in
departments other than those with equipment operators and maintenance staff.
These are usually administrative staff.
Such administrative expenses are often hidden in sub-divisions of the administration

budget. Categories of expenditure which may fall under the budgets of departments
other than the equipment user or maintenance department could include:
For Equipment Use:

Equipment-related departmental operating costs (such as materials, literature, fuel)
which are necessary for work, safety and record-keeping activities to take place.
For Equipment Maintenance:

Departmental operating costs (such as materials, literature, fuel, utilities, staff costs)
which are necessary for work, safety, travel and record-keeping activities to take place.
Please note: This Section only covers the general planning and budgeting of the
administration side of maintenance work. In contrast, Guide 6 provides a full
explanation of the daily financial management required by HTM Teams so that they
can undertake maintenance work, undertake other equipment management tasks,
and run a workshop.
153
Who is Responsible for Calculating Administrative Costs?

- HTM Working Groups Need to learn how to budget for administrative costs
- Heads of Department
- HTM Managers
- Finance Officers
Any health facility, workshop Can make calculations of administrative costs
budget allocations
- runs its service as a business
- cover the needs of many business plans
facilities
details
Facility, workshop or district Are more likely to make more exact detailed
service levels estimates for annual requirements.
How To Calculate Equipment-related Administrative Costs

You can make:
Box 32
◆ or exact estimates for annual requirements, as shown in Figure 23.
It is difficult to make global rough estimations for long-term plans, but Box 32
provides suggestions from various countries.
154
Box 32: Suggestions for Rough Estimations of Equipment-related Administrative Costs for
Forward Planning
Different countries suggest alternative approaches:

i. Administrative costs are a small percentage of any operating budget, for example:
◆ the biggest percentage expense is for staff, taking 50–55 per cent
◆ supplies/spares take 35–45 per cent

◆ administration only takes 10–20 per cent
Thus an equipment-user department could use an average of 15 per cent of their total operating budget
for administrative costs.
ii. For HTM Teams and maintenance workshops, their administrative needs are not much higher than other
administrative units in health facilities.
Therefore, a reasonable estimate for the administrative costs for HTM Teams could be calculated by
taking 10–20 per cent of their total operating budget.
iii. A starting point is to use five per cent of the equipment stock value to cover equipment-related
administrative costs.
requirements.
Figure 23: How to Make Specific Estimates of Assorted Equipment-related Administrative

Costs Annually
Process Activity
HTM Managers:
Evaluate their requirements for administrative costs, such as:

• salaries of the maintenance staff
• overheads of the workshops, such as electricity
Identify their needs • fuel allocations
• stationary, forms, records
• literature, written resources, and subscriptions
• communications - telephone bills
• protective clothing.
Liaise with the relevant budget holders to ensure that they place
Ensure they are reflected in the
sufficient estimates in their budgets for expenditures affecting
relevant budgets
equipment maintenance work and services.
Heads of Equipment-User Departments:

Evaluate their requirements for equipment-related administrative
costs, such as:
• stationery, forms, records
Identify their needs
• literature, written resources, and subscriptions
• protective clothing
• fuel allocations.
Liaise with the relevant budget holders to ensure that they place
Ensure they are reflected in the
sufficient estimates in their budgets for expenditures affecting
relevant budgets
equipment operational services.
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6.4 Ongoing training costs
Experience from Mozambique

The Ministry of Health discovered the dangers of underestimating some aspects of the
equipment-related administrative costs. In Mozambique, the travel costs for maintenance
departments can be extremely expensive.
The travel expenses allocated per day work out to be equivalent to one-third of the
monthly salary of a technician. Thus a technician applying for three days travel effectively
doubles their monthly salary.
The provinces planned for two days per month of travel per technician. To achieve this, they
would have to budget for an additional 67 per cent of the technicians’ salaries each month.
6.4 ONGOING TRAINING COSTS

In order to maximize your staff skills and make the best use of equipment, you will need
to draw up an annual training budget, covering ongoing equipment-related training.
Your HTM Working Group, or a smaller training sub-group (Section 1.2), should
develop an Equipment Training Plan to cover the rolling programme of refresher
training required by your staff (Section 7.2). This is needed in order to ensure adequate
skill development in all areas of equipment use, maintenance, and management.
Section 5.4.2 has covered the cost of initial training that is linked to the arrival of
equipment purchases. However, there will be other ongoing training needed
throughout the year to cover:
◆ induction training – when staff are newly placed in post, move to a new
department/facility, or move to a new location with different responsibilities

◆ refresher training – to update and renew skills throughout the working life of staff.
Equipment-related skills development will be required in the following areas (see

Guides 4 and 5):
◆ good practice when handling equipment – basic ‘dos and don’t’s’
◆ how to operate equipment
◆ the correct application of equipment
◆ care and cleaning
◆ safety procedures
◆ planned preventive maintenance (PPM) for users
◆ PPM and repair for maintainers
◆ assorted activities as applied specifically to equipment needs, such as
procurement, tender adjudication, stores management, financial management and
computing skills.
156
There are a wide range of options available for developing skills, using the training
provided by the following sources:
◆ equipment suppliers
◆ other health facilities, workshops, or health service providers

◆ academic or vocational training institutions
◆ on-the-job learning and practical experience
◆ self study and peer group support.
These are described in full in Box 40 in Section 7.2, and each facility will need to
use a combination of the strategies available.
You will require a variety of resources when training staff, whether someone else trains
them or you do it yourselves. These vary depending on the training source and skill-
development option you choose (see above and full description in Box 40). Box 33
shows the type of resources which you will usually have to organize and finance.
BOX 33: Resources Required when Training Staff
Resources Required if Sending Staff Away for Training:

Information about the training required (background and needs assessment) and the
training sources available (see Box 40 in Section 7.2).
Expenses overnight accommodation, travel and subsistence for the trainees,
trainers’ fees or course fees, plus any other likely costs.
Records a system for keeping a record of the specific training that a staff member
has received.
Recognition a formal way of ensuring that the additional skills attained by staff
are reflected in their promotion chances and job grades by the Human
Resource Department.
Additional Resources if Running the Training Courses Yourselves:

Training materials appropriate to the piece of equipment to be studied (see Guides 4 and 5).
Space suitable for carrying out the training in.
Equipment to be practised on during the training courses.
Test and calibration instruments in order to verify technical conditions and safety during training.
Spare parts and materials appropriate for maintenance training.
Supplies consumables, medical supplies, and cleaning materials for user training.
Manuals to refer to, such as manufacturers’ operator and service manuals.
Test method and certificate a formal way of testing trainees and issuing them with a certificate at the
end of the training course, as a quality control and motivating factor
(depending on the extent of the training).
Additional expenses possible room hire, overnight accommodation, travel and subsistence for
the trainers, trainers’ fees, visual aids/teaching equipment, etc.
157
Who is Responsible for Calculating Ongoing Training Costs?

- HTM Working Group, or Need to learn how to budget for ongoing training
smaller training sub-group needs
- Finance Officer
Any health facility, workshop Can make ongoing training calculations
budget allocations
- runs its service as a business
A service level (such as facility Will find the calculations here most useful for exact
or district) that makes: estimates
- detailed estimates for
annual requirements
Service levels (such as central Only need to make rough estimates for their long-
or regional/district levels) term forward plans and budget allocations.
that:
facilities
details
Tip • The service level which makes these calculations will have to know about, or obtain
information about, the staffing and training requirements at each site.
How To Calculate Ongoing Training Costs

You can make:
Box 34
◆ or exact estimates for annual requirements, as shown in Figure 24.
It is difficult to make global rough estimations for long-term plans, but Box 34
provides suggestions from various countries.
158
Box 34: Suggestions for Rough Estimations of Equipment-related Ongoing Training Costs
for Forward Planning
Different countries suggest alternative approaches:

i. Plan and budget for ongoing training costs by using a percentage of staff costs (the salary budget).
Generally, ongoing training costs can be taken as two per cent of payroll costs.
ii. Plan and budget for ongoing training costs by using a percentage of the equipment stock value. As a
starting point, ongoing training costs can be taken as five per cent of the stock value.
Figure 24 describes how to make exact estimates for annual requirements.
Figure 24: How To Make Specific Estimates of Annual Equipment-related Ongoing

Training Costs
Process Activity
HTM Working Group (or its training sub-group):
Identify:
• activities in the Equipment Training Plan (Section 7.2) which
Annually, evaluates skill were not achieved in the previous year;
development needs • requests for training interventions prompted by reports of
poor performance with equipment (see Guides 4 and 5), and
monitoring (Section 8.2).
Identify:
Identifies the inputs required • the training sources to be used (see Box 40 in Section 7.2);
• the resources required to undertake the training (see Box 33).
Plan the requirements for the rolling programme of on-the-job

Makes a plan for ongoing training
training for the coming year.
Cost the training requirements for the coming year's activities,

Costs the plan
using the advice in Figure 17 (Section 5.4.2).
Obtains approval Submit the costs to the Health Management Team.
Consult the central health service provider to establish:

• which training activities can be financed from central activities
Identifies the sources of funds • what scholarships are available
• whether there is assistance available from external support
agencies.
Allocate sufficient funds from the budget to cover the in-house

Provides the finances
training programme for the year.
159
Section 6 summary
Once you have learnt how to undertake these recurrent budget calculations, as
described in this Section, you can use them to make your long-term Core Equipment
Expenditure Plan (Section 7.3) and to undertake annual budgeting (Section 8.1).
An example of a total recurrent budget plan is given in Section 7.3.
BOX 35: Summary of Procedures in Section 6 on Recurrent Budget Calculations
HTM Working ◆ make rough estimations of maintenance costs for long-term forward plans and budget
Group, HTM allocations, by using a percentage of the equipment stock value (see Figure 20)
Maintain
Manager, Finance
Officer
HTM Managers ◆ make specific or annual estimates of maintenance costs, by costing specific
in Workshops requirements (see Box 29 and Figure 21)
HTM Working ◆ make rough estimations of consumable operating costs for long-term forward plans
Operate
Groups and budget allocations, by considering the suggestions relating to a percentage of

the equipment price (see Box 30)
Heads of ◆ make specific or annual estimates of consumable operating costs, by costing specific
Department requirements (see Figure 22)
HTM Managers ◆ make rough estimations of administrative costs for long-term forward plans and
and Heads of budget allocations, by considering the suggestions relating to a percentage of the
Admin
Department equipment stock value or departmental operating budgets (see Box 32)
◆ make specific or annual estimates of administrative costs, by costing specific
requirements (see Figure 23).
HTM Working ◆ make rough estimations of ongoing training costs for long-term forward plans and
Group budget allocations, by considering the suggestions relating to a percentage of the
(or Training equipment stock value or payroll costs (see Box 34)
Tr a i n i n g
Sub-group) ◆ make annual estimates of ongoing training costs, by costing specific requirements
(see Figure 24)
Health ◆ consult with the health service provider on central training plans, and scholarships
Management available
Teams ◆ lobby them for external resources for the training required.
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7. How to use the tools to make long-term equipment plans and budgets
7. HOW TO USE THE TOOLS TO MAKE

LONG-TERM EQUIPMENT PLANS AND
BUDGETS

If you have a large amount of equipment needs, you require a method of
prioritizing between them for your health facility or service level. An Equipment
Development Plan will help you to define which equipment you can afford to
concentrate on, in any given year.
The development of the equipment stock will help you to identify the range of
equipment-related training required by your staff. Therefore you need an
Equipment Training Plan to cover all aspects of equipment-related skill
development in an ongoing rolling programme.
To finance these plans, you need a Core Equipment Expenditure Plan which
ensures you allocate sufficient funds (both capital and recurrent) to provide
functioning healthcare technology over the long-term. You will also need a
Core Equipment Financing Plan which ensures you identify sufficient sources
of funds to cover your needs.
In this Section, we will show you how to apply the planning tools you have
established (Sections 3 and 4) and the budgeting tools you have previously learned
(Sections 5 and 6), for the purpose of making long-term plans and budgets.
Undertaking planning and budgeting together is important. Even if you have agreed
upon the type of equipment to buy (determined by planning), you can only purchase
what you can afford (determined by budgeting, prioritizing, and financing).
Facilities regularly identify equipment requirements. However they may have more
needs than they can afford, in which case they will need to prioritize them.
Currently, all facilities are faced with a number of unavoidable facts:
◆ They need a wide range of equipment if they are to provide the health services
they wish to offer.
◆ All equipment should be functioning, but many items are not working, thus
affecting the services that can be offered.
◆ Due to the age and shortfall of equipment, many different new items are required.
◆ Staff require a range of different equipment-related skills, but many staff have not
received the necessary training.
◆ Each year there are only limited funds available to address these issues.
161
7. How to use the tools to make long-term equipment plans and budgets
Therefore, it is very important that each facility, service level, and health service
provider is able to plan its response to this situation by undertaking an Equipment
Planning and Budgeting Process.
It is preferable to undertake forward planning and budgeting. This enables you to

plan ahead and determine your needs and actions in the near future (one to two
years) and the longer-term (three to five years). For this, you will have to:
◆ identify your equipment needs
◆ cost them
◆ identify sources of funds
◆ prioritize which activities you can afford and when they should take place.
In addition, your health service provider or the owner of your facility (such as a
Board) may wish to develop a strategic or business plan which is less detailed. This
enables you to make rough estimations of the long-term financial requirements for
the development of your health facility or service level, so that you can forecast the
need to raise money or recover costs.
This Section concentrates on the following long-term plans and budgets:

◆ an Equipment Development Plan (Section 7.1)
◆ an Equipment Training Plan (Section 7.2)

◆ your Equipment Budget – made up of a Core Equipment Expenditure Plan and a
Core Equipment Financing Plan (Section 7.3).
Once you have developed these long-term goals, you will need to undertake an
annual planning and budgeting process within these goals. Also, the long-term plans
will need to be updated to reflect your annual plans and changes in circumstance.
These issues are described in Section 8.1. The equipment rehabilitation, purchase,
and training goals which you set should be monitored each year to see if they have
been achieved (Section 8.2).
7.1 EQUIPMENT DEVELOPMENT PLAN (EDP)

Each facility and service level usually makes plans and sets itself targets which
prioritize its departmental work activities for the coming year (see Guides 4 and 5).
However, such annual action planning usually focuses on the improvements that can
be achieved with existing equipment, and specifically omits the major investments
required for additional equipment. Your Equipment Development Plan is the
means for the facility to set itself rehabilitation, replacement, purchase, and
corrective goals for its equipment stock.
162
7.1 Equipment development plan (EDP)
If you have a large quantity of needs to improve your equipment stock, you require a
method of prioritizing between the needs across your facility or service level, since
you will not be able to buy everything at once. An Equipment Development Plan will
help you to do this, by defining which items of the equipment you need to
concentrate on in any given year.
Why Equipment Development Planning is Necessary

An Equipment Development Plan brings to your attention information about:
◆ the current stock of equipment (medical equipment, plant, service supply
installations, fabric of the building)
◆ the condition of the equipment
◆ the basic shortfalls in equipment
◆ the action required to rehabilitate, replace, purchase, or correct problems
◆ what should be attempted in both the short- and the long-term.
The Equipment Development Plan will be of help because it:

◆ identifies and forecasts your requirements in advance
◆ clarifies the direction of development

◆ allows cost estimates to be made for the actions required
◆ highlights where you need to allocate funds, and helps you to rationalize resources
◆ enables you to focus on the areas where fund-raising is required
◆ provides you with a time-frame for monitoring that the development is achieved.
The actions you must take are to:

◆ use the planning tools established (Sections 3 and 4)
◆ evaluate the current equipment stock and its needs
◆ evaluate your future requirements
◆ adhere to your purchasing, donations, replacement, and disposal policies
◆ present your decisions as the long-term Equipment Development Plan.
Tip • As can be seen from your purchase and donations policies (Section 4.4), the majority
of purchases are likely to be for replacing existing stocks as they reach the end of
their lives. Equipment should only be replaced for valid reasons as determined by
the criteria given in your replacement and disposal policies (Section 4.4).
• All your capital expenditure requirements should be covered by the Equipment
Development Plan. Thus all requests for replacement equipment, additional new
items, and major rehabilitation needs, should only be honoured if they are part of the
long-term goals detailed in the Equipment Development Plan.
163
Who is Responsible for Equipment Development Planning?

Preference
Equipment development planning should be undertaken by a multi-disciplinary team, so that
single types of staff (such as clinicians) do not have too much influence.

- HTM Working Group, or Is responsible for Equipment Development
smaller planning sub-group Planning
- HTM Team (which
prepares background
technical information)
At facility level It is possible to undertake basic equipment
development planning
At service levels (such as Require a bulk equipment development planning
district, region, or centre) that process, most likely computerized, possibly with
cover: specialist support
- the needs of many items of
equipment
- many different locations.
Tip • If you want to gain from standardization of equipment and economies of scale, it is
better to undertake needs assessment and procurement at a service level that covers
many health facilities (Section 2.2). Therefore try to collaborate in these tasks.
Principles Involved in Basic Equipment Development Planning

Figure 25 shows the basic process involved in equipment development planning.
However, to make the necessary decisions you should undertake some analysis of the
data you are studying. Box 36 illustrates the principles involved for the analysis, in
relation to the activities shown in Figure 25.
164
Figure 25: The Basic Equipment Development Planning Process
Process Activity
The HTM Manager and his/her HTM Team:
• Analyze the up-to-date Equipment Inventory (Section 3.1):

- to discover the replacement, major rehabilitation,
maintenance, consumable, training, and administrative
requirements.
Evaluates the current equipment • Compare the Equipment Inventory with the Model Equipment
stock List (Section 4.3):
- to discover the shortfall of equipment that needs purchasing.
(If the Model Equipment List is not available, compare the
inventory to the urgent equipment needs drawn up by
departments).
Evaluates future requirements • Study the Vision for the facility:

- to discover any new services planned.
Compiles the needs • List all these requirements
The HTM Working Group (or its planning sub-group):
Prioritizes the actions to take, and • Decide what to attempt:

makes the Equipment - as short-term goals (in the coming year or two)
Development Plan - as long-term goals (for example, within three to five years).
• Create plans for:

- equipment replacement and new purchases, and any
Prepares various Action Plans associated support activities
- major rehabilitation projects
- corrective actions (maintenance, consumable needs, training,
administrative needs).
165
BOX 36: Analysis Required for the Equipment Development Planning Process (in Figure 25)
Analysis Method of Measurement
HTM Manager and his/her Team:

◆ When analyzing the up-to-date Equipment Inventory:
Discover the condition of the a. Identify those items needing maintenance and repair (including
equipment. maintenance contracts).
b. Identify those items requiring major rehabilitation (including
maintenance contracts).
Note: It may be necessary to set priorities for renovating equipment
if you have a large backlog. A good indicator (way of measuring this)
is to monitor each year what percentage of your Equipment
Inventory has been returned to working order. Provide the HTM
Working Group with this percentage figure (see below).
Discover: c. Identify those items to be scrapped and not replaced, according

- where the equipment is in its life- to the replacement and disposal policies (Section 4.4).
cycle (refer to typical lifetimes in d. Identify those items needing replacement, according to the
Annex 3). replacement and disposal policies.
- whether the health service that can Note: It may be necessary to set priorities for replacing the
be delivered is deteriorating. equipment if you have a large backlog. A good indicator of priorities
is to monitor what percentage of your Equipment Inventory is
beyond its expected lifespan. Provide the HTM Working Group with
this percentage figure (see below).
Discover what hinders the use of e. Identify where consumable and administrative inputs are
equipment required.
f. Identify where training is required (this information will be used
when developing the Equipment Training Plan – Section 7.2).
◆ When comparing the Equipment Inventory with the Model Equipment List:
Discover the shortfall of equipment g. Identify those items which are missing and must be purchased,
in the existing facility. according to the purchasing and donations policies (Section 4.4).
Note: It may be necessary to set priorities for purchasing the missing
equipment. A good indicator of priorities is to monitor each year
what percentage of the Model List is covered by your Equipment
Inventory. Provide the HTM Working Group with this percentage
figure (see below).
◆ When studying the Vision for the facility:

Discover any new services to be h. Identify those new additional items of equipment which must be
offered by the facility in the purchased, according to the purchasing and donations policies.
long-term.
Continued opposite
166
BOX 36: Analysis Required for the Equipment Development Planning Process (in Figure 25)
(continued)
Analysis Method of Measurement
HTM Working Group (or its planning sub-group):

◆ When prioritizing which actions a–h (above) will be attempted:
Decide which actions will be ◆ Ensure the equipment remains in good working order – refer to
achieved: the indicator provided by the HTM Manager (see point b above).
- as short-term goals (in the coming ◆ Ensure the health service delivered does not deteriorate – refer
year or two) to the indicator provided by the HTM Manager (see point d
- as long-term goals (for example, above).
within three to five years). ◆ Follow the principles in the purchase/replacement policies – refer
to the indicator provided by the HTM Manager (see point g
above).
◆ Conform to the available finances for the facility.
◆ Consider how important the equipment is for clinical operations
(see discussion of priorities in Section 8.1).
The first time you establish an Equipment Development Plan, you consider the
needs for a span of around five years. After that, you update and modify the
information annually (Section 8.1) to create a rolling programme of action plans.
To help you to review all the necessary actions and prepare the Equipment
Development Plan, you can use an Equipment Development Plan Record Sheet to
lay out the needs.
Layout of the Equipment Development Plan

A variety of layouts can be used for the Equipment Development Plan (EDP). Box 37
(overleaf) shows a possible layout of the Record Sheet used to capture the details,
which can then be used to help create your final EDP. Your equipment inventory will
be used as the first column on the Record Sheet. You can decide how best to sort your
inventory data (Section 3.1). In the example shown, the inventory is sorted by
location.
The EDP Record Sheet (Box 37) is ordered according to department (area, or
room), with each column providing different information and highlighting decisions
which need to be made. The activities recommended in these columns can form the
basis of your short- and long-term Action Plans. If you wish, you can add on extra
columns to record rough price estimates for the purchases and actions you propose.
This is useful, as you will need these estimates as the basis for your cost calculations
when preparing your Core Equipment Expenditure Plan (Section 7.3.1).
167
It is possible to mark up a printed copy of your Inventory, then type up the decisions
made in the column format of the EDP Record Sheet. However, creating an EDP is
easier if you have computerized records and know how to create spreadsheets. This
is discussed further in the next section on creating a bulk EDP.
Ultimately, it may be easier to work from a Summary EDP, rather than a large pile of
EDP record sheets. The summary combines the data and presents all the action
plans for the short term and long term in one place. Box 38 (overleaf) shows how
you might summarize the data from your EDP record sheets, and continues the
example started in Box 37. It assumes that the health facility concerned is large
enough to have an HTM workshop of its own and shows its needs. In smaller
facilities these requirements would be covered by the EDP for the district/regional
HTM Service.
How to Create a Basic Equipment Development Plan at Facility Level

At facility level you can go as far as you like. For example:
◆ you could simply follow the basic equipment development planning process
shown in Figure 25
◆ in addition, you could undertake the analysis described in Box 36
◆ you can make use of an EDP Record Sheet to assist you with laying out the
details, as shown in Box 37
◆ you can also develop a summary of your plans, as shown in Box 38.
How To Create a Bulk EDP at Service Levels which Cover Many

Facilities
Larger facilities (tertiary) and district, regional, or central health authority levels should
have drawn up equipment inventories on all assets. However, preparing an Equipment
Development Plan on the basis of analyzing each item would be an enormous amount of
work. You will therefore require strategies to make the task less of a burden.
If you only consider complex and large items of equipment, you risk omitting small
but important items. In many countries, it is common for the needs of major items to
be well addressed, but for smaller, essential items to be ignored due to the high level
of effort involved in calculating the numbers required. Since small equipment and
instruments are just as important and are used by many members of staff, planning
for this type of equipment should be done in a way which relieves the burden of the
administrative procedure.
Often, procurement may be triggered not by the size and complexity of equipment,
but by the price bracket. Since many small items used by many staff members can
add up to a large amount, they should not be forgotten. The same principles as those
described for basic equipment development planning are used, but instead you
consider the equipment in categories for a bulk EDP. Box 39 provides examples of
strategies that can help.
168
BOX 37: Example of the Layout for an Equipment Development Plan Record Sheet
Description:
Department/Room:
Column 1 Column 2 Column 3 Optional Column 4 Column 5 Optional Column 6

Equipment Condition Short Term Action Price Estimates Longer Term Action Price Estimates
a. Existing equipment & its Age & Expected life. Short term action required Rough price estimates of short Longer term action (things Rough price estimates of
particulars (type of equipment, Condition of the equipment, (things that should happen term actions. that must happen within longer term actions.
the make, your inventory code such as: within the following couple of 3–5years), such as:
number). • working or not; years), such as: • rehabilitate
• details of problems. • rehabilitate • replace
b. Additional equipment Codes can be used for • replace • buy for the first time
required to provide basic condition (ie. poor, fair, • buy for the first time • continue corrective actions,
services, which is currently excellent) and to show • undertake corrective actions, such as hiring a maintenance
absent. This reflects the replacement is needed, eg. such as training users, buying contractor.
equipment levels defined in • damaged beyond consumables, hiring a
the Model Equipment List (see • repair technically maintenance contractor.
Section 4.3). • obsolete clinically,
etc.
Example:
Department/Room: X-RAY DEPARTMENT, DARKROOM
Equipment Condition Short Team Action Price Estimates Longer Term Price Estimates
(optional) Action (optional)
Automatic film processor, 8 years old, used all Use local contractor to US$ 75 Enter into a new US$ 100 p.a.
Kodak RP X-omat, BD654321 the time; not serviced service. maintenance
enough; maybe wrong Educate staff. US$ 25 contract.
chemicals Buy correct consumables. US$ 250 p.a.
Manual processor, 30 yrs old, not working, Replace to ensure manual US$ 3,000
Kodak P3, BD:1453 parts missing. back-up is available.
Red safe lights Need red filters. Purchase filters. US$ 30

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170
BOX 38: Example of a Summary Equipment Development Plan
Action Department Needs Price Estimates US$ Short-term Long-term
(optional)
2004 2005 2006 2007 2008
Equipment to casualty 1 x ECG recorder 12,000 x x x x x
replace casualty 1 x ambulance 30,000 x x x x x
CSSD 2 x instrument sets 5,000 x x x x x
dental 1 x dental suite 19,000 x x x x x
laboratory 1 x fridge/freezer 500 x x x x x
laboratory 2 x microscopes 4,000 x x x x x
maternity 2 x infant incubators 13,000 x x x x x
mortuary 1 x 3-body box & plant 14,000 x x x x x
paediatrics 1 x oxygen tent & humidifier 1,500 x x x x x
theatre 2 x diathermy units 15,000 x x x x x
theatre 2 x suction pumps 3,000 x x x x x
theatre 2 x operating theatre lights 30,000 x x x x x
wards 20 x light fittings 700 x x x x x
workshop assorted hand tools 4,000 x x x x x
X-ray 1 x manual film processor 3,000 x x x x x
New equipment to administration 1 x computer & printer 2,500 x x x x x

purchase labour and OPD 3 x foetal heart detectors 1,200 x x x x x
physiotherapy 1 x ultrasound unit 5,000 x x x x x
waste handling 1 x incinerator 10,000 x x x x x
workshop 1 x safety tester 3,500 x x x x x
Major buildings water storage tanks 4,000 x x x x x

rehabilitation buildings roof 15,000 x x x x x
projects kitchen cold room and plant 5,000 x x x x x
service installations overhaul generating set 7,000 x x x x x

wards overhaul all beds 3,000 x x x x x
Maintenance maternity introduce PPM for incubators 200 p.a. x x x x x

corrective actions service installations introduce PPM for plumbing 600 p.a. x x x x x
(add to general service installations introduce PPM for electrics 700 p.a. x x x x x
annual needs) theatre service anaesthetic machines 400 x x x x x
theatre maintenance contract for anaesthetic machines 600 p.a. x x x x x
X-ray service automatic film processor 75 x x x x x
X-ray maintenance contract for automatic film processor 100 p.a. x x x x x
Consumable casualty source ECG recorder supplies 6,000 p.a. x x x x x

corrective actions maternity/physio source ultrasound gel 200 p.a. x x x x x
(add to general theatre source operating theatre light bulbs 140 p.a. x x x x x
annual needs) X-ray source red safe-light filters 30 p.a. x x x x x
X-ray source correct developer and fixer 250 p.a. x x x x x
Administrative library subscriptions for literature 300 p.a. x x x x x

corrective actions user departments maintenance report files 30 p.a. x x x x x
(add to general workshop safety clothes 400 p.a. x x x x x
annual needs) workshop maintenance record files 15 p.a. x x x x x
Training needs laboratory skills in photometer repairs 50 x x x x x

(forward to Equip- theatre user PPM for suction pumps 10 x x x x x
ment Training X-ray correct use of film processor chemicals 25 x x x x x
Plan – Section 7.2)
Box 39: Ways of Categorizing Equipment for a Bulk EDP
Strategy Example
Consider major items of equipment Include:

per department - medical equipment
- service provisions (such as electrical installations,
steam reticulation, sewage and water pipelines)
- elements of the fabric of the building (such as doors,
windows or roof)
Consider individually: For example:

- those items of equipment above a certain value - above US$500
- those items of equipment above a certain size - not handheld items (such as diagnostic sets), possibly
not portable items (such as resuscitators/ambu bags)
Lump together: For example:

- small items which are used by many staff - stethoscopes and sphygmomanometers
so the large quantities required can be
purchased in bulk
- items which can be considered collectively - instrument sets, kitchen crockery and cutlery,
as larger ‘sets’ and toolkits
Use a computerized process to help with the See Annex 2 for information on suitable software
number-crunching
At a service level requiring a bulk EDP:

◆ use the strategies shown in Box 39 to categorize your equipment into groups
◆ follow the basic planning process shown in Figure 25

◆ undertake the analysis described in Box 36
◆ use an EDP Record Sheet to lay out the details, as shown in Box 37
◆ develop a summary of your plans, as shown in Box 38.
For a bulk EDP covering many items or many facilities, you could type up the
information but it is easiest if you have computerized your records. Then you simply
enter the data into the computer according to the EDP layout, and use trained
technical staff and secretarial or computing support to assist with data entry.
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7.2 Equipment training plan (ETP)
With access to computers and spreadsheets, you could employ further columns in the
EDP record sheet or the summary EDP to hold additional useful data. For example,
you could programme the columns with codes for:
◆ the condition of equipment, and therefore its need for replacement or
maintenance
◆ the number of years left in the equipment’s lifetime, and therefore when it is
likely to need replacing
◆ how many additional pieces of equipment you need to meet the standard level set
in the Model Equipment List, and therefore the need for new purchases
◆ a running total of the possible rough costs involved
◆ your decisions on which actions to take in which year.
7.2 EQUIPMENT TRAINING PLAN (ETP)

Once you have drawn up an Equipment Development Plan (Section 7.1), you can
use this to tailor your training requirements.
If you want to maximize your use of equipment, a wide range of staff require training
in equipment-related skills throughout their careers. To ensure that healthcare
technology needs are not forgotten, the Equipment Training Plan (ETP) is an
essential planning tool.
The first time you establish an ETP, you will need to consider the equipment
training requirements over the long-term, for example for five years. After that, you
can simply update and modify the information annually (Section 8.1) to create an
ongoing programme of equipment-related skills development.
Skill Development Requirements
on-the-job seminars going to college
Types of Training
Healthcare technology is developing rapidly, with new models and makes of
equipment appearing almost every year. Health service providers need to be able to
cope with this wide range of rapidly changing products. Unfortunately, problems with
equipment often arise due to mishandling by users, or a failure to understand fully
how the equipment works. In order to be able to use and maintain the equipment
found in health facilities effectively, training must therefore be seriously addressed.
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Throughout their careers, your staff will need both:

◆ basic training, and
◆ additional skill development opportunities.
The basic health training requirements for medical staff are generally covered by the
Human Resources Development Plan. However, it is common for health service
providers to forget:
◆ basic training and career development requirements for maintenance staff (for a
description of the needs, see Guide 1)
◆ specific training modules on equipment operation for medical and support staff
(see Guide 4)
◆ equipment-related training needs of general staff, such as purchase officers, stores
staff and finance officers (see Guides 3 to 6).
Major training needs (such as long courses, training abroad or specialization training)
may have to be covered by the capital budget.
Experience from Southern Asia

The Human Resource Development Division of the Ministry of Health in one Southern
Asian country is responsible for training but has no specific budget for equipment or
facility-related training.
Their budget for training is small, and only gets used for clinical skills for new recruits
(such as nurses and laboratory technicians). None is used for maintenance technicians,
skills in equipment operation, or upgrading equipment knowledge.
Although they use the WHO country budget to get funds for assorted training needs, this
is not sufficient to keep up with new technical advancements.
Equipment-related skills development will be required in the following eight areas:

◆ good practice when handling equipment – basic ‘dos and don’ts’
◆ how to operate equipment

◆ the correct application of equipment
◆ care and cleaning
◆ safety procedures
◆ planned preventive maintenance (PPM) for users
◆ PPM and repair for maintainers
◆ assorted activities as applied specifically to equipment needs, such as
procurement, tender adjudication, stores management, financial management and
computing skills.
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This range of training is required at varying times throughout a member of staff ’s

career. Key training stages include:
i. induction training – when staff are newly placed in post, move to a new
department/facility, or move to a new location with different responsibilities
(Section 6.4)
ii. training at the commissioning of equipment – when new equipment first arrives
(Section 5.4.2)
iii. refresher training – to update and renew skills throughout the working life of
staff (Section 6.4).
Monitoring how equipment works and how it is used will provide prompts that
training is required, which should be passed onto the Health Management Team
(Section 8.2). Figure 26 shows the likely prompts.
Figure 26: Example of Prompts Showing that Training is Required
Prompt Response
Staff newly arrived at a facility, or In-Service Training Co-ordinator organizes induction

transferred between departments training on equipment-related skills
Staff admit that they need any type of

They request it from their Head of Section
equipment-related training
Heads of Section see that staff are short They request the necessary training from the
of particular equipment-related skills HTM Working Group (or its training sub-group)
Maintenance staff identify user-related

They report this to the HTM Manager
problems with equipment
New equipment arrives at the health The training sub-group/Commissioning Team

facility organizes this
An incident report is submitted The HTM Working Group, or its safety sub-groups,
(see Guide 4) decides if extra training is the appropriate solution
Managers agree with the individual which training

Skill shortages are discovered during the would be the best development strategy,
staff appraisal process (see Guide 4). and request it from the Human Resource
Department/training sub-group
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Sources of Training Available

There are a number of options available for developing skills, and each facility has to
use a combination of the strategies shown in Box 40.
Whichever options prove to be the most feasible, a skills development programme is

vital. The health service provider organization plays a significant role at central level,
such as:
◆ developing training plans
◆ organizing and providing training scholarships

◆ approaching donors to finance training programmes.
Therefore equipment training requirements at facility or district/regional level

should be submitted to the central body of your health service provider organization.
BOX 40: Strategies for Developing Equipment Skills
Strategy Advantage/Disadvantage
Send staff to factories that This can be good training but may be expensive as it often entails going
manufacture equipment abroad and paying in foreign currency. However, the company may have a
(this may be appropriate local representative that has the skills to provide the training; this will be
for high-cost equipment). a more affordable option. Dangers are that the manufacturer will offer a
course which is too simple (not much more than a factory tour), or
alternatively a very theoretical course. Good communication is required
to ensure that the training is appropriate to maximize the potential of
this equipment-specific training.
Invite engineers from If you are facing financial constraints, it may not be possible to afford this
manufacturers to visit your easily. However if the company’s local representative has sufficient skills
facility to conduct training and can offer a well-organized plan for on-site training, this can be more
on their equipment. affordable.
Send staff to other locations Other facilities/workshops/teams may already have developed skills that
which have already developed you need. Here your staff can either attend specific training courses, or
the skills required. have a period of secondment in order to obtain skills through on-the-job
training, work experience, or work exchange visits.
Link the provision of training When equipment is purchased from a company, you ask them to provide
to the procurement process. training at the time of commissioning (see Guide 3). Who covers the cost
of the training and where it will take place is negotiated in the
procurement contract, and may be dependent on the type and total cost
of the equipment.
Run in-house (on-the-job) You can make use of local, national, or regional experts who are
training sessions maintenance and/or clinical staff. It may be necessary to send some staff
for training abroad so that they can become the local trainers/experts.
Make use of regular These can be used as a forum to introduce staff to particular equipment
clinical/professional meetings concerns. They can be run at facility, district, central, or international levels.
Continued overleaf
175
BOX 40: Strategies for Developing Equipment Skills (continued)
Strategy Advantage/Disadvantage
Make use of academic These are useful for gaining additional specialist skills. They will be
courses at various levels available nationally, regionally, and overseas (see Annex 2).
Approach local colleges to - The Trade Testing Authority can develop trade tests suited to the
develop, run, and accredit range of skills used by artisans/craftsmen who maintain healthcare
new modules specifically technology, so they can progress in their careers.
designed for your - The Polytechnic can combine a mixture of existing engineering
equipment needs modules to create a certificate or diploma course suited to the range of
skills used by technicians who maintain healthcare technology, so you
can hire and train more suitably qualified staff.
- The health colleges (who provide basic training for nurses, doctors,
physiotherapists, and other health practitioners) can introduce new
modules aimed at developing equipment-related skills for equipment
users.
Provide opportunities for Practical experience, with or without supervision, provides excellent
practical on-the-job training as long as it is at the right skill level. When a piece of equipment is
experience not in use, staff should be encouraged to familiarize themselves with the
equipment, and learn its principles and its different uses and problems.
Provide opportunities for Books, manuals, and articles from journals will give answers to many
studying and teaching questions on principles of operation and maintenance for different types
of equipment (see Annex 2). If staff are given opportunities to study,
with a little pressure/expectation to lecture to colleagues afterwards, the
benefits for individuals can be great.
Let the different types of staff This allows staff to share experiences regarding equipment, learn from
(both equipment operators their colleagues, and develop a professional approach to work. The
and maintainers) attend their meetings will be available nationally and internationally.
peer group meetings
Provide various training The materials, together with demonstrations, help staff to learn and
materials for staff to refer to provide them with something to regularly refer to when uncertain. The
(see Guides 4 and 5). materials can be hand-outs, posters, OHP acetates, laminated cards, etc.
Provide work placements This will raise your profile and give you contacts with training
for student maintainers in institutions. The students may also return to you for employment when
your workshop they graduate, and you will already have a good idea of their abilities.
Resources Required
You will require a variety of inputs when undertaking training, and they will vary
depending on the training source and skill-development option chosen (as described
in Box 40). Box 33 (Section 6.4) shows the type of resources which you will
usually have to organize and finance.
176
Who is Responsible for Developing the Equipment Training Plan?

HTM Working Group, or Is responsible for establishing all training
smaller training sub-group requirements
Every level Needs to develop an overall Equipment Training
Plan to cover all aspects of equipment-related skill
development, and pass it on to higher levels.
Higher levels (such as district, Must include equipment training plans developed
region, and central level) at lower levels into their service-wide equipment
training plans.
Tip • If you want to gain from economies of scale, it is better to undertake needs
assessment and organize training courses at a service level that covers many health
facilities (Section 2.2). Therefore try to collaborate in these tasks.
How to Create an Equipment Training Plan

The Equipment Training Plan should be an annually-updated rolling programme
of training covering many years. At service levels compiling and overseeing plans for
many facilities, the use of computers and spreadsheets will make the task easier.
Figure 27 shows how to create an Equipment Training Plan.
Box 41 provides an example of an Equipment Training Plan, and continues the

example from Box 38. It assumes that the health facility concerned is large enough
to have an HTM workshop of its own and shows its needs. For smaller health
facilities, these requirements would be covered by the Equipment Training Plan for
the district/regional HTM Service.
As Box 41 shows, if you wish you can have an optional column where you record
rough cost estimates of the training planned. This is useful as you will need to make
these calculations later anyway when preparing your Core Equipment Expenditure
Plan (Section 7.3.1).
177
Figure 27: Making an Equipment Training Plan
Process Activity
The HTM Working Group (or its training sub-group):
Refers to:
• any record the HTM Manager made when analyzing the
Identifies existing needs Equipment Inventory that training was required – see point f. in
Box 36 (Section 7.1)
• any prompts, triggers, or requests for training
reported/submitted.
Studies the Equipment Development Plan (EDP) and identifies

the training required to deal with:
• planned equipment replacements
Identifies new needs • planned new equipment purchases/donations or additional
services
• problems with equipment operation, maintenance, or
management.
Considers:
• the eight different areas for equipment-related skill
development listed in this Section – basic handling, operation,
application, care and cleaning, safety, user PPM, PPM and
Determines the range of training
repair for maintainers, associated skills (procurement, stock
that will satisfy the needs
control, financial management, etc)
• the three types of training required at different times in the
working life of staff (induction, at commissioning, and
refresher training).
Considers:
• the various sources of training (described in Box 40), which
Determines the sources that will provide the option for on-the-job or external courses
provide the needs • any initiatives organized and provided by the central health
service provider organization and donor programmes.
Prioritizes across the needs Prioritizes the short- and long-term actions.
Prepares an overall Equipment Covers all aspects listed above for equipment-related skill
Training Plan development.
The Health Management Team:
Abides by the plans made Only acts according to the agreed plans, unless emergencies
arise (Section 8.2)
178
BOX 41: Example of an Equipment Training Plan
Type of Needs Short-term Long-term Trainees (Numbers) Source of Training Price Estimates
Training US$
2004 2005 2006 2007 2008 (optional)
Application For example:

ophthalmoscopes x x x x x clinical officers (3) eye doctor
training 10
Operator ECG recorder use x x clinical officers & nurses (8) in-house technicians 10
re-training film processor chemical use x x X-ray assistants (2) local manufacturer’s representative 25
PPM for users suction pumps x theatre nurses (9) in-house technicians 10
Upgrade operator casualty equipment x nurses & clinical officers (8) placement at referral hospital casualty 10
skills laundry procedures x laundry staff (6) central laundry supervisor 25
Re-training for photometers repairs x technicians (2) local manufacturer’s representative NOTE:
maintainers solar panel repairs x artisans (2) in-house engineers the price
estimates will
PPM for compressors x x x x x artisans (2) in-house senior artisans depend on the
maintainers bench-top autoclaves x x x x x technicians (2) in-house engineers training
ambulance x x x x x technicians (2) in-house senior technicians resources
infant incubators x x x x x technicians (1) visit manufacturer’s factory required (as
detailed in
Box 33,
Upgrade skills of craft certificates x x x x x artisans (2) local Trade Testing Centre Section 6.4)
maintainers technical diplomas x x x x x technicians (2) local Polytechnic
Management skills equipment record-keeping x HTM Team members (5) HTMS – central level
Safety skills use of safety tester x technicians (2) in-house engineers
New equipment use of diathermy machines x x x x x surgeons (3) in-house engineers

arrivals computer use x x x x x admin-secretarial staff (5) local College
incinerator maintenance x x x x artisans (2) local manufacturer’s representative
use of physio ultrasound x x x x physiotherapist (2) local manufacturer’s representative
Create trainers in use of Bowie & Dick tests x x CSSD staff (1) infection control officer
in user PPM for incubators x x midwives & ICU staff (2) in-house technicians
179
7.3 Equipment budget – financial plans
7.3 EQUIPMENT BUDGET – FINANCIAL PLANS

Having drawn up a long-term Equipment Development Plan and Equipment
Training Plan, you need to identify and allocate the finances to cover your proposed
actions. To do this, you need an Equipment Budget. This ensures you have
sufficient funds (both capital and recurrent) to provide functioning healthcare
technology over a set period of time.
Any budget should have two parts to it:

◆ the income portion identifies the funds you have coming in, or must find
◆ the expenditure portion identifies how you wish to spend the money, and
therefore how to allocate the funds.
Thus you need a Core Equipment Financing Plan (CEFP) and a Core
Equipment Expenditure Plan (CEEP).
For government health facilities, your income usually consists of only the funds given
to you by government from its own finances, and the development funds provided by
external support agencies. However, if your health facility is more autonomous, it is
your responsibility to also identify various possible sources of income from fund-
raising and income-generating activities.
The financial planning process is circular:

◆ you need to know the income available before you can spend it
◆ however, you need to know what you plan to spend before you can raise funds.
It is necessary to start the discussion at some point in the cycle; therefore this
Section discusses:
◆ the Core Equipment Expenditure Plan in Section 7.3.1
◆ the Core Equipment Financing Plan in Section 7.3.2.
7.3.1 Core Equipment Expenditure Plan (CEEP)

The expenditure plan can be developed in two ways:
◆ A General CEEP for the Health Management Team, which displays the funds
required for the short- and long-term actions proposed in your Equipment
Development Plan (EDP) and Equipment Training Plan (ETP). This will form
the basis of your allocations and spending every year.
◆ A Strategic Business Plan for the health service provider (or Board/Trustees).
This makes use of rough estimations to provide a long-term financial overview so
that they can forecast the need for raising money or recovering costs.
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7.3.1 Core equipment expenditure plan (CEEP)
The expenditure plan should be designed according to your budget lines (or sub-
divisions) for capital and recurrent costs. However, it is important to try and use the
planning tool developed in Section 3.3, so that the budget is laid out with sufficient
budget lines to show how money is allocated for different equipment requirements.
In this way, you can adequately monitor how the money is spent on equipment.
Tip • Part of financial planning is to ensure that you manage the allocations between
different expenditure requirements. Your aim is to obtain an effective balance
between capital and recurrent expenditure. For example, there must be a balance:
– between the amount spent on capital items, and sufficient allocations for the
recurrent costs required to keep the items functioning (including costs such as
consumables, maintenance and training)
– between the amount spent on staff salaries, and the amount spent to ensure there
is sufficient equipment for the staff to work with.
Who is Responsible for Developing Equipment Expenditure Plans?

- HTM Working Group, or Is responsible for equipment expenditure planning
smaller training sub-group
- Finance Officers
Which Level? Takes what action?
Any service level Can prepare a general CEEP by budgeting for the
proposed actions in the Equipment Development
Plan and Equipment Training Plan
Service levels such as Can prepare rough estimations for a strategic
autonomous or donor-targeted business plan
facilities, districts, regions, or
the centre
How to Create a CEEP

If you have a large number of activities and requirements as part of your long-term
Equipment Development Plan and Equipment Training Plan, you must calculate
the expenditure required and balance the needs across the facility.
To do this, you simply use your ‘budgeting tools’ for rough estimations (Sections 5
and 6) to cost each element, with the strategic CEEP using the quickest roughest
estimates. Then you summarize the results and present them as the expenditure
portion of your budget. At service levels compiling and overseeing plans for many
facilities, the use of computers and spreadsheets will make the task easier.
Of course, you then need to ensure that the central financing body of your health
service provider accepts your plan and honours it. You will also need to identify a way
of financing your needs (Section 7.3.2).
181
182
Figure 28: Making a Core Equipment Expenditure Plan
Process Activity
Decide which type of CEEP to Do you want to prepare a general or a strategic

prepare Core Equipment Expenditure Plan?
A General CEEP based on your EDP and ETP, A Strategic CEEP based on rough estimations,
for allocating finances for your short- and long-term actions for long-term forecasting of fund-raising needs
Use the total of the price estimates from the Equipment

Development Plan (EDP) (Section 7.1), and calculations from Use your equipment stock value (Figure 8, Section 3.2), and
Calculate the replacement costs
Box 23 (Section 5.2). Leave the percentage for support calculations from Figure 14 (Section 5.1).
activities as a capital line item of its own – see below.
Use the price estimates from the EDP (Section 7.1), and Choose a percentage of the items missing from your Model
Calculate the new purchase calculations from Box 23 (Section 5.2). Leave the percentage Equipment List that you can afford, to increase your equipment
costs for support activities as a capital line item of its own – see stock levels. For help see the indicator under point g. in Box 36
below. (Section 7.1) and the third goal in Box 48 (Section 8.2).
Combine the percentage for support activities from the two

Calculate a percentage of the replacement and new totals
Calculate the cost of support calculations above, giving a total for all equipment replacement
activities for purchases above, using Box 23 for guidance (Section 5.2).
and new purchases according to Box 23 (Section 5.2).
Calculate the cost of Use the price estimates from the EDP (Section 7.1), and Calculate a percentage of the replacement and new totals
pre-installation work calculations from Boxes 26 and 25 (Section 5.2). above, using Box 26 and 25 for guidance (Section 5.2).
Choose a percentage of your equipment stock that you can

Calculate the cost of major Use your stock values or price estimates for the equipment afford to return to working condition. For help see the indicator
rehabilitation projects concerned, and calculations from Box 27 (Section 5.5) under point b. in Box 36 (Section 7.1) and the second goal in
Box 48 (Section 8.2).
Use your equipment stock value (Figure 8, Section 3.2), and Use your equipment stock value (Figure 8, Section 3.2), and
Calculate the maintenance costs calculations from Figure 20 (Section 6.1). Ensure the amount is calculations from Figure 20 (Section 6.1). Ensure the amount is
greater than last year, to cover corrective actions planned. greater than last year, to cover corrective actions planned.
Continued opposite
Figure 28: Making a Core Equipment Expenditure Plan (continued)
Use your equipment stock value (Figure 8, Section 3.2), and Use your equipment stock value (Figure 8, Section 3.2), and
Calculate the consumable costs calculations from Box 30 (Section 6.2). Ensure the amount is calculations from Box 30 (Section 6.2). Ensure the amount is
greater than last year, to cover corrective actions planned. greater than last year, to cover corrective actions planned.
Use either the relevant operating budget or your equipment Use either the relevant operating budget or your equipment
Calculate the administrative stock value, and calculations from Box 32 (Section 6.3). Ensure stock value, and calculations from Box 32 (Section 6.3). Ensure
costs the amount is greater than last year, to cover corrective actions the amount is greater than last year, to cover corrective actions
planned. planned.
Use either your salary budget or equipment stock value, and Use either your salary budget or equipment stock value, and
Calculate the on-going training calculations from Box 34 (Section 6.4). Ensure the amount is calculations from Box 34 (Section 6.4). Ensure the amount is
costs greater than last year, to cover corrective actions planned. greater than last year, to cover corrective actions planned.
Lay out these expenditure Use the different budget lines (sub-divisions) a – i, developed Use the different budget lines (sub-divisions) a – i, developed
requirements in a useful way in Box 10 (Section 3.3). in Box 10 (Section 3.3).
Either by typing up the data or entering it into the computer. Either by typing up the data or entering it into the computer.
Compile the Core Equipment
Technical staff who have been trained and secretarial/ Technical staff who have been trained and secretarial/
Expenditure Plan (CEEP)
computing support can be used to assist with data entry. computing support can be used to assist with data entry.
By developing the Core Equipment Expenditure Plan as an By developing the Core Equipment Expenditure Plan as an
Manage the CEEP active (regularly updated) computer file, as well as a hard active (regularly updated) computer file, as well as a hard
copy print-out. copy print-out.
To: • the health service provider (or Board, Trustees, etc.)

To: • the Health Management Team for approval
Submit the CEEP for approval and use
• the central financing body so they can honour it.
• the central financing body for fund raising purposes.
Only spend funds on equipment-related activities according to Combine the CEEP with the Core Equipment Financing Plan
Make use of the CEEP the details presented in the Core Equipment Expenditure Plan. (Section 7.3.2) to make a strategic business plan to present to
potential funding sources.
Update the CEEP annually Follow the procedures described in Section 8.1 Follow the procedures described in Section 8.1
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184
Box 42: Example of a Core Equipment Expenditure Plan
Capital Expenditure Short-term Long-term

Total
(US$) 2004 2005 2006 2007 2008
Replacement 48,000 NOTE: In this example of a general Core Equipment Expenditure

Plan, the rough prices from the Equipment Development Plan
(Box 38, Section 7.1) and the Equipment Training Plan (Box 41,
New equipment 2,000 Section 7.2) have been increased by the percentage required for
Use calculations for the ’package of material inputs’ (see Box 23, Section 5.2), and the
Support activities linked to rough estimations total placed in the year column.
purchases from Section 5 (see 5,000
Note below)
Pre-installation 2,000 NOTE: Rough estimations of these capital costs have been
calculated based upon the prices from the example Equipment
Development Plan (Box 38, Section 7.1), and the totals placed
Rehabilitation 7,000 in the year column.
Sub-Total 64,000
Recurrent Expenditure
(US $)
Equipment maintenance 25,000

Consumables Use calculations for 20,000 NOTE: The rough prices in the Equipment Development Plan and
rough estimations the Equipment Training Plan are already included in these rough
from Section 6 (see estimations of general recurrent needs per year.
Administration Note below) 6,000
On-going training 15,000
Sub-Total 66,000
Total Expenditure 130,000
Note: Initially, rough estimations are used for the short- and long-term overview when preparing this Core Equipment Expenditure Plan. During annual planning
(see Section 8.1) the estimates are revised using calculations for specific requirements, to obtain your Annual Equipment Budget. The experience you gain from
that annual revision process may mean that you have to alter the long-term estimates in this Core Equipment Expenditure Plan, so that they are more realistic.
Figure 28 (page 182) shows how to create a CEEP. This will help you to budget for
the finances required to achieve your health service delivery goals over a set period.
Box 42 shows a possible layout for a Core Equipment Expenditure Plan using the
various budget lines (subdivisions) discussed in Section 3.3. It continues the
example started in Boxes 38 and 41.
How to Create a Strategic Business Plan

The aim of this plan is to ensure that functioning healthcare technology will be
provided, at the level defined by the Model Equipment Lists (Section 4.3), by the
end of a specified period – possibly five or 10 years.
To create a strategic business plan, you simply combine your strategic CEEP with an
outline core equipment financing plan (Section 7.3.2). Depending on your type of
health service provider and your level of autonomy, you can then use this strategic
business plan to raise the necessary finances by approaching potential sources of
funding. You can also use it when planning how to recover costs.
7.3.2 Core Equipment Financing Plan (CEFP)

Having drawn up your Core Equipment Expenditure Plan (either general or
strategic), you need to identify funds from various sources to finance the equipment
expenses. These elements will be laid out in a Core Equipment Financing Plan,
which forms the ‘income’ portion of your Equipment Budget.
You then use the CEFP to allocate the necessary finances. Depending on your type
of health service provider and your level of autonomy, these finances may come from
a variety of different internal, national, or international sources.
Who is Responsible for Developing the Core Equipment

Financing Plan?
- HTM Working Group, or Is responsible for developing the equipment
smaller planning sub-group financing plan
- Finance Officers
Any service level Can prepare a CEFP as the income portion of their
equipment budget
Service levels such as Are most likely to use the CEFP as part of their
autonomous or donor-targeted strategic business plan for fund-raising purposes.
facilities, districts, regions, or
the centre
185
7.3.2 Core equipment financing plan (CEFP)
How to Create a Core Equipment Financing Plan (CEFP)

To create a CEFP, you simply consider your capital and recurrent needs per year from
your CEEP (see Box 42), and determine which type of funding source can finance
which element. Then the results are summarized and presented as the income
portion of your Budget.
Box 43 (overleaf) shows a possible layout for a Core Equipment Financing Plan, and
continues the example figures from Box 42. The layout uses a variety of entries
showing income sources that are either:
◆ internal (your own), such as patient fees, income generating projects
◆ national, such as government grants, sponsorship from local businesses/clubs; or

◆ international, such as grants and loans from external support agencies.
At service levels compiling and overseeing plans for many facilities, the use of
computers and spreadsheets will make the task easier.
Either yourself or the central financing body of your health service provider will need
to ensure that fund-raising activities are carried out and finances are obtained, so
that the planned expenditure (Section 7.3.1) can be allocated. By combining the
Core Equipment Financing Plan with your strategic business CEEP, you can draw up
a strategic business plan to present to potential funding agencies.
Figure 29 shows how to create a CEFP, and allocate sufficient funds to achieve your
health service delivery goals over a set period.
Once you have undertaken the one-off exercise to establish these long-term plans, as
described in this Section, you then update and modify the information during the
annual planning process (Section 8) to create a rolling programme of equipment plans.
186
Figure 29: Making a Core Equipment Financing Plan
Process Activity
Refers to the Core Equipment

Identify expenditure requirements
Expenditure Plan (Section 7.3.1)
Identify:
• internal funds available from your own resources, such as your
budget, sales of equipment, fees, or income generating
projects
Considers available funding
• national funds available from government or your health
sources
service provider, such as grants, loans, donations, sponsorship
from local clubs, or promotional activities
• identify international funds available from external support
agencies, such as grants, loans, or donations.
Allocates finances against all Identify which sources can finance which expenditure
expenditure needs requirements.
Lays out the financing plan Use the example of a Core Equipment Financing Plan in Box 43
according to the various funding to present the income according to internal, national, and
sources international sources.
Either by typing up the data or entering it into the computer.

Compiles the Core Equipment
Trained technical staff and secretarial/computing support can
Financing Plan (CEFP)
be used to assist with data entry.
By developing the CEFP as an active (regularly updated)

Manages the CEFP
computer file, as well as a hard copy print-out.
To:
Submits the CEFP • the health service provider (or Board, Trustees, etc.) for
approval and use
• the central financing body for fund raising purposes.
By:
• applying for grants, loans or donations, fund-raising, starting
income generating projects, and lobbying for finances
Implements the CEFP
• combining the CEFP with the Core Equipment Expenditure
Plan to create a strategic business plan and presenting it
potential funding bodies.
Uses the CEFP when allocating Only allocate funds for equipment expenditures according to the
funds details presented in the Core Equipment Financing Plan.
Updates the CEFP annually Follow the procedures described in Section 8.1.
187
188
Box 43: Example of a Core Equipment Financing Plan
2004 2005 2006 2007 2008
Capital Recurrent Capital Recurrent Capital Recurrent Capital Recurrent Capital Recurrent
Financial Resources Expenditure Expenditure Expenditure Expenditure Expenditure Expenditure Expenditure Expenditure Expenditure Expenditure
Own Resources
Accumulated retained surplus 500
from previous years
Income from sale of equipment 500
Patient fees 2,000
Income generating projects 3,000
etc.
Sub-Total 1,000 5,000

National Resources
Government grants For capital and recurrent 34,000 60,000

requirements, insert rough
Government loans estimates of likely incomes 1,000
from:
Donations * known sources 1,000
* your fund-raising efforts
Local business sponsorship * promises 1,000 1,000
(see Note below)
etc.
Sub-Total 37,000 61,000

International Resources
External support agency grants 20,000

External support agency loans 5,000
Donations 1,000
etc.
Sub-Total 26,000
The figures must equal the
Total NOTE: In this example, figures from the sample Core Equipment
totals in your Core Equipment 64,000 66,000
Expenditure Plan (Box 42, Section 7.3.1) have been used
Expenditure Plan
Note: Initially, rough estimates are used for the short- and long-term overview when preparing this Core Equipment Financing Plan. During annual planning (see Section 8.1) the estimates are revised to
reflect actual incomes obtained. The experience you gain from that annual revision process may mean that you have to alter the long-term estimates in this Core Equipment Financing Plan, so that
they are more realistic.
Section 7 summary
BOX 44: Summary of Procedures in Section 7 on Making Plans and Budgets
HTM Working ◆ uses the planning tools to establish an Equipment Development Plan for the short-
Group and long-term, either:
(or Planning - a basic one at facility level (according to Figure 25), or
Sub-group) - a summarized one at higher service levels (using strategies in Box 39)
EDP
◆ updates the Equipment Development Plan annually (Section 8.1)
Health ◆ implements the Equipment Development Plan

Management
Team
HTM Working ◆ uses the Equipment Development Plan and training requests to establish an
Group Equipment Training Plan as an ongoing rolling programme (according to Figure 27)
(or Training ◆ updates the Equipment Training Plan annually (Section 8.1)
Sub-group)
ETP
Health ◆ consults with the health service provider organization in order to:
Management - identify the central training plans
Team
- identify the scholarships available
- lobby for external resources for the training required
◆ implements the Equipment Training Plan.
HTM Working ◆ uses the Equipment Development Plan, Equipment Training Plan, and budgeting
Group tools to establish either a general or strategic Core Equipment Expenditure Plan
(or Planning (CEEP) for the short- and long-term (according to Figure 28), as the expenditure
Sub-group) portion of the budget
◆ considers all possible funding sources to establish a short- and long-term Core
Equipment Financing Plan (CEFP) as the income portion of the budget (according
Budget
to Figure 29)
◆ updates the Core Equipment Expenditure Plan and the Core Equipment
Financing Plan annually (Section 8.1)
◆ combines the strategic CEEP and the CEFP to create a Strategic Business Plan to
present to potential funding sources when fund-raising.
Health ◆ implements the Core Equipment Expenditure Plan

Management ◆ implements the Core Equipment Financing Plan
Team
◆ makes use of the strategic business plan.
189
190
8. How to undertake annual planning, budgeting and monitoring
8. HOW TO UNDERTAKE ANNUAL

PLANNING, BUDGETING, AND
MONITORING

Having drawn up your short- and long-term equipment plans and budgets,
you will need to carry out some annual planning and budgeting to find out
what activities you can attempt each year within these goals. This allows you
to revise the overall plans as time goes by.
Managing the activities described in this Guide will involve a cycle of actions.
You need to monitor your performance, and set yourself goals so that you can
improve. Then you monitor your progress, revise your goals, and review your
progress again – thus undertaking a continuous cycle of planning and review.
Such evaluation helps you to ensure the quality of your work. This is one
element of quality management – an important goal for managers.
The planning and review activities are interlinked in a cycle, as shown in Figure 30,
but it is necessary to start the discussion at some point in the cycle. This Section
discusses:
◆ the annual planning and budgeting process (setting goals) in Section 8.1
◆ the review process (monitoring progress) in Section 8.2.
Figure 30: The Planning and Review Cycle
action
Set/Revise Monitor
Goals Performance/Progress
feedback
191
8. How to undertake annual planning, budgeting and monitoring
All staff involved in equipment planning and budgeting should be involved in

planning and reviewing their progress with this work. Therefore, this Section is
relevant for all different types of personnel, including:
◆ staff from the equipment-user departments
◆ HTM Teams
◆ HTM Working Groups (managers, technicians, finance officers, health workers, etc.)
◆ their various sub-groups.
The main outcome of the planning and review process is that you are able to evaluate
your performance. This is important for ensuring the quality of your work (quality
assurance), which is an essential component of quality management.
Aims of Quality Management

◆ client satisfaction
◆ cost efficiency
◆ compliance with laws
We recommend that quality management is introduced into the health management

systems of all the decentralized levels of the health service. It can help to improve
staff attitudes and this, in turn, can help staff handle the challenges connected with
the many reforms and new management tasks they face (such as those described in
this Guide). Important elements of quality management are:
◆ a management team approach
◆ supervision and evaluation

◆ participative leadership
◆ methods for encouraging staff
◆ individual responsibility and initiative
◆ control measures such as performance measurements and impact analysis
◆ community participation.
8.1 ANNUAL EQUIPMENT PLANNING AND

BUDGETING (SETTING GOALS)
Each facility and service level needs to have goals and plans which set out their
priority activities. The goals and plans must be clearly defined so that they guide the
work of:
◆ health facilities
◆ service levels
◆ their staff
◆ the health service as a whole.
192
8.1 Annual equipment planning and budgeting (setting goals)
The goals and plans also enable staff and managers to monitor their own performance
and progress with regard to the planning and budgeting of equipment.
Every department or team can benefit from Annual Action Plans which contain
clear, specific goals relating to its key activities. An action planning process should
take place once a year, as standard practice. This is an opportunity for the teams to
agree the range of activities (initiatives and changes) they want to implement.
The annual action planning process for normal departmental activities is described
in Guides 4 and 5. However, there are boundaries and limitations to such
departmental planning, and the needs for major investments in equipment, staff,
and resources are normally discussed outside their annual process. In this Guide, we
outline the planning processes required for such major investments. For example:
◆ major equipment needs fall under the Equipment Development Plan (Section 7.1)
◆ skill development for equipment falls under the Equipment Training Plan
(Section 7.2), although hiring of staff and other skill development needs fall
outside the scope of this Guide
◆ resources for equipment fall under the Equipment Budget (Section 7.3),
although resources for other aspects of healthcare work also fall outside the scope
of this Guide.
Having drawn up short-term (one to two years) and longer-term (three to five
years) equipment plans and budgets, you will need to carry out the following
activities annually:
◆ review the activities planned for the year
◆ determine the activities you can pursue
◆ identify and allocate your funds for those purposes
◆ revise the long-term plans.
This is the annual planning and budgeting process, and involves:

◆ identifying needs
◆ costing them
◆ prioritizing which activities will occur in the coming year.
From the Equipment Development Plan you need to prioritize your requirements
annually according to available funds, and therefore determine the:
◆ Annual Purchase Activities (APA) for replacement and new equipment, including
all material inputs (stocks of accessories, consumables, spare parts) and associated
work (such as pre-installation, installation, commissioning, initial training)
◆ Annual Rehabilitation Activities (ARA) for major large-scale renovation projects
◆ Annual Corrective Activities (ACA), for undertaking repairs, introducing PPM,
increasing consumable inputs, and ensuring administrative inputs are available.
193
From the Equipment Training Plan you need to prioritize your requirements
annually according to available funds, and therefore determine the:
◆ Annual Training Activities (ATA).
These capital and recurrent requirements combined will determine the expenditure
and income portions of your Annual Equipment Budget (AEB).
All your long-term plans (and many of your planning tools) are active records. In other
words, they must be kept up-to-date if they are to be of any use. Data used for planning
and budgeting purposes is of little help if it is out of date. Identifying equipment needs
on an annual basis enables you to keep your plans and tools up-to-date.
Who is Responsible for Annual Planning and Budgeting?

- HTM Working Group, or Are responsible for annual planning and budgeting
its planning sub-group and
training sub-group
- HTM Team (which
prepares background
technical information)
Every service level Needs to undertake annual planning and budgeting
How to Undertake Annual Planning and Budgeting

The timing of your actions is important. Your plan must be produced in time for your
health service provider’s deadline for submitting budget estimates. This will be
determined by the timing of the financial year, and the time required for the
negotiation process between your health service provider and the central financing
authority. Figure 31 shows a time-line in your annual calendar for the steps in your
planning and budgeting process, in relation to your health service provider’s deadlines.
As Figure 31 illustrates, the process of undertaking annual planning and budgeting

involves the following six steps:
Step 1 – Update your Equipment Inventory
Step 2 – Review your Equipment Development Plan to determine your annual needs
Step 3 – Review your Equipment Training Plan to determine your annual needs
Step 4 – Cost the annual needs
Step 5 – Review your Core Equipment Expenditure Plan and Core Equipment
Financing Plan, prioritize the needs, and prepare proposed annual plans
Step 6 – Update existing plans with final agreed Annual Plans and Budgets, once
funding has been approved.
194
Figure 31: Annual Calendar for the Planning and Budgeting Process
TARGET DATE
Time intervals throughout the year
Step 1
Annual Date set by Date when

Step 2 health feedback is
inventory
update service received
Annual Step 3 provider for from health
review of submission service
Equipment Annual of budget provider on
Development Step 4 estimates your actual
review of
Plan (EDP) Equipment budget
Cost the Step 5 allocations
Training EDP and
Plan (ETP) ETP Review Core Equipment
Expenditure Plan (CEEP) and
Core Equipment Financing Plan
(CEFP), prioritize funds, and
propose annual plans and Step 6
budgets
Update
long-term
plans and
budgets
with agreed
and financed
annual
actions
Annual Purchase Activities

Annual Rehabilitation Activities EDP
Annual Corrective Activities ETP
Annual Training Activities CEEP
Annual Equipment Budget CEFP
195
The activities you need to undertake for each of these six steps are outlined over the
following pages.
Step 1 – Update your Equipment Inventory

Use the process shown in Figure 32.
Figure 32: Updating the Equipment Inventory as part of the Annual Planning Process
HTM Manager and his/her Team (from a workshop):
Throughout the previous year, correct the existing record with

Ensures that the inventory details on:
master/computer record • new equipment arrivals
contains the updated When? • service history details (see Guide 5) on equipment no longer
information gathered during working
the year • equipment taken out of service
Prints out a hard copy of the Identify:

current Equipment Inventory Tothe
• write notessources
training on during
to the equipment
be used inventory
(see Box up-date7.2);
40 in Section
Why?
(Section 3.1). process.
• the resources required to undertake the training (see Box 33).
Every year, prior to the Equipment Development Planning

Organizes a formal inventory process, and in time for the preparation/submission of budget
update When? estimates (set at a time in the calendar determined by your
health service provider organization – see annual calendar in
Figure 31).
To:
Sends an inventory team • physically check equipment
(Section 3.1) to visit each Why? • update the inventory records, using either the hard-copy print
department out or some type of data-capture form (such as the one shown
in Box 5, Section 3.1).
To decide whether it is time to condemn a piece of equipment

Discusses the findings Why? according to the principles in the Replacement and Disposal
Policies (Section 4.4).
Include:
• those items of equipment which present problems (and require
corrective actions – consumables, training, repairs, etc)
• those items requiring major rehabilitation
• those items condemned/written off
Compiles a written report How? • those items requiring replacement, according to the
replacement and disposal policies (Section 4.4).
NOTE: Since the condemning and disposal of equipment is

meant to automatically trigger its replacement (Section 4.4), the
HTM Manager refers to his equipment disposal records (see
Guide 4) and ensures these items are included in the report.
Submits this report to the HTM In time for the annual review of the Equipment Development
Working Groups (or its planning When? Plan – Step 2 of the annual planning and budgeting process
sub-group) (see Figure 33).
Updates the inventory master/ How? Enter the notes from the marked-up print-out or the data-capture
computer record forms onto the master record in order to update it.
196
Step 2 – Review your Equipment Development Plan and determine your

needs for the coming year
Figure 33: Reviewing the Equipment Development Plan to Determine your Annual Needs
Ensures it updates the After the Equipment Inventory update (Figure 32), and in time for
Equipment Development Plan When? the preparation and submission of budget estimates
(EDP) annually (see Figure 31)
Print out a hard copy of the To determine which of last year's planned actions were not
Why?
EDP (Section 7.1). completed and are still outstanding.
To study the current details on:

Considers the report submitted • problem equipment
by the HTM Manager following • those items requiring corrective actions, such as maintenance,
the Equipment Inventory Why? consumables, administrative inputs, etc.
update (see Step 1 – Figure 32) • those items requiring major rehabilitation
• those items already condemned
• those items requiring replacement
To determine:
Talks to users and department • their priorities
Why? • urgent needs for absent equipment (items from the Model
heads
Equipment List which are missing).
Reviews the intended plans for To decide:

the coming year from the Why? • if any changes should be made
long-term EDP • which actions should be attempted in the coming year
Draws up the equipment

To be considered when all needs are prioritized – Step 5 of the
development proposals for the Why?
annual planning and budgeting process (see Figure 36).
coming year
In time for the annual review of the Equipment Training Plan –

Passes the EDP proposals Step 3 of the annual planning and budgeting process
When?
onto the training sub-group (see Figure 34).
By:
• correcting any of the equipment particulars, as necessary
Revises the existing EDP on file • making any alterations regarding the condition of the
according to its layout (see How? equipment
Boxes 37 and 38, Section 7.1) • adding to the list any equipment required to provide new
services, which may have arisen from changes in the Vision
(Section 4.2).
Updates the existing EDP with

the decisions for the coming After the plans are finalized – Step 6 of the annual planning and
year and any implications for When? budgeting process (see Figure 37).
the long-term.
197
Step 3 – Review your Equipment Training Plan and determine your needs
for the coming year
Figure 34: Reviewing the Equipment Training Plan to Determine your Annual Needs
HTM Working Group (or its training sub-group):
Ensures it updates the After the review of the Equipment Development Plan (Figure 33),
Equipment Training Plan (ETP) When? and in time for the preparation and submission of budget
annually estimates (see Figure 31).
To review:
• which of last year's planned actions were not completed and
are still outstanding (Section 8.1)
• the intended plans for the coming year from the long-term
Print out a hard copy of the Why? Equipment Training Plan
ETP (Section 7.2). • the requests for training interventions prompted by the
Equipment Development Plan (see Figure 33), reports of
performance with equipment (see Guides 4 and 5), and
monitoring (Section 8.2).
By considering:
• the staff and trainers to be trained in the coming year (see
Determines the relevant Figure 17, Section 5.4.2)
training requirements How? • the training sources to be used (see Box 40, Section 7.2)
• the resources required to undertake the training (see Box 33,
Section 6.4).
To decide:
Talks to users and department
Why? • if any changes should be made to existing plans
heads about their priorities
• which actions should be attempted in the coming year
Draws up the training To be considered when all needs are prioritized – Step 5 of the
proposals for the coming year Why? annual planning and budgeting process (see Figure 36).
Passes the training proposals In time for the costing of proposed plans – Step 4 of the annual
When?
onto the planning sub-group planning and budgeting process (see Figure 35).
Updates the existing ETP with

the decisions for the coming After the plans are finalized – Step 6 of the annual planning and
When? budgeting process (see Figure 37).
year and any implications for
the long-term.
198
Step 4 – Cost the annual needs using the calculations for specific
(annual) estimates
Figure 35: Costing Your Annual Needs

After the annual planning process (Figures 32 – 34), and in time

Ensures it costs the proposed
When? for the preparation and submission of budget estimates (see
annual plans
Figure 31).
• use Boxes 24 & 25 (Section 5.2) to cost purchases of

replacement equipment and new items, together with their
‘packages’ of material and transport inputs
• use Figure 16 (Section 5.4.1) to cost any installation and
commissioning work
• use Figure 17 (Section 5.4.2) to cost any initial training linked
Refers to the proposed annual to the purchases
equipment development and • use Figure 15 (Section 5.3) to cost any pre-installation work
training plans, and costs the How? • use Figure 18 (Section 5.5) to cost major rehabilitation work
proposed actions using the (including maintenance contracts)
specific (annual) estimates • use Box 29 & Figure 21 (Section 6.1) to cost maintenance
requirements (including maintenance contracts)
• use Figure 22 (Section 6.2) to cost any operating consumable
requirements.
• use Figure 23 (Section 6.3) to cost any administrative
requirements;
• use Figure 24 (Section 6.4) to cost any on-going training
requirements.
Remember:
• if you reduce the proposed amount of replacement items to
be purchased, you must increase the maintenance budget as
it will have to cover existing old equipment (Section 6.1);
Ensures there is a correct • if you reduce the maintenance budget, you should increase
balance between capital and How? the amount of replacement items to be purchased so that more
recurrent budgets of the facility's equipment stock can be returned to a working
and repairable condition (Section 5.1);
• if you plan to purchase new additional items of equipment,
you must increase the recurrent budgets for maintenance and
consumables as they will have to cover the running costs of a
larger stock of equipment (Section 3.3).
For example:
Checks the totals to ensure the * the maintenance estimate is a suitable percentage of the
estimates are of the right order How? equipment stock value (see Figure 20, Section 6.1)
of size * the replacement estimate is a suitable percentage of the
equipment stock value (see Figure 14, Section 5.1).
Lays out these expenditure Use the different budget lines (sub-divisions a–i – see Box 10)
requirements in a useful way How? developed in Section 3.3.
Considers possible funding Use the different income elements of the Core Equipment
sources for different elements How? Financing Plan (internal, national, and international – see
of expenditure Box 43) developed in Section 7.3.2.
Uses these budget proposals

Follow Step 5 of the annual planning and budgeting process
when prioritizing the annual How? (see Figure 36).
needs
199
Step 5 – Review the Core Equipment Expenditure Plan and Core

Equipment Financing Plan, prioritize what you can do in the
coming year, and prepare various proposed Annual Plans
Use the process shown in Figure 36, having considered the following issues.
It is quite common to be faced with a wide range of tasks, so you will need to
prioritize between them. If money is short, you must choose to cut activities in such
a way as to minimize the effect on healthcare delivery. The tasks you attempt can be
chosen according to how important the equipment is for clinical operations. For
example, one suggestion is to concentrate on:
plant covering: medical equipment covering:

sterilization operating theatres (e.g. suction pumps)
electricity supply (including the generator) syringes
water supply anaesthetics
laundry basic laboratory (e.g. microscope)
refrigeration ultrasound (maternal/obstetric)
kitchen X-ray departments
steam for heating labour/delivery
sewage and sanitation installations basic diagnostics (e.g. BP machines)
cooling/air-conditioning (if climate is very hot)
Contrary to popular belief, sophisticated and electronic medical equipment are not
always the most important items to own and maintain. In terms of patient care and
comfort, items such as sufficient water, power generation for operating theatres,
effective sterilizers, and good beds are of greater importance than ECG or X-ray
machines. Box 45 shows a strategy used by some planners for working out which
equipment should be the first priority for purchase or corrective actions.
200
BOX 45: The VEN (or VED) System for Prioritizing Actions
Planners in several countries use a VEN (VED) system which helps to set priorities for taking actions on
equipment and deciding what to do first. Under this system, you do not simply consider the value or
complexity of the equipment or task, but you consider the effect on health service delivery if the equipment
is not available for use. Thus items are categorized as:
Vital – items that are crucial for providing basic health services and should be kept
functioning at all times (for example, electrical generator, operating theatre light,
suction pump in the theatre, mortuary refrigerator)
Essential – items that are important but are not absolutely crucial for providing basic health
services and a period when they are out of operation can be tolerated (for example,
suction pump in a ward, dental compressor, physiotherapy ultrasound)
Not so essential/ – items that are not absolutely crucial for providing basic health services. In other
Desirable words, it is possible to adapt and plan around their absence if they are out of
operation (for example, ECG recorder, lift, a back-up X-ray machine).
The same types of equipment can have various different classifications depending on their location. For
example, a microscope may be considered ‘vital’ in the main laboratory but only ‘not so essential/desirable’ in
the out-patients department (OPD).
If funds are limited, actions involving vital items should be given first priority, followed by those involving
essential items, and so on.
201
Figure 36: Reviewing the Core Equipment Expenditure Plan and Core Equipment Financing
Plan, Prioritizing the Allocation of Funds, and Preparing Proposed Annual Plans
and Budgets.
Ensures it prioritizes and After the annual costing process (Figure 35), and in time for the
prepares the annual plans When? submission of budget estimates (see Figure 31).
and budgets
Prints out a hard copy of the To review:

Core Equipment Expenditure • the expenditure and income intended for the coming year in
Plan (CEEP) and Core Why? the long-term plans
Equipment Financing Plan • which of last year's planned expenditures were not spent
(CEFP) (Section 7.3) • which of last year's planned incomes did not materialize.
Studies the proposed costs To decide:

and incomes for the year, • if any changes should be made to the expenditure plans
made in Step 4 of this annual Why?
• which actions can be covered by the financing plans.
process (see Figure 35)
According to:
• the overall goals in the long-term Equipment Development
Plan, Equipment Training Plan, and Core Equipment
If the annual needs are too Expenditure Plan
great, prioritizes the • the principles of the purchasing, donations, replacement
requirements across the How?
and disposal policies (Section 4.4);
service level as a whole • the available finances and goals of the Core Equipment
Financing Plan;
• how important the equipment is for clinical operations
(see Box 45).
• the proposed purchases for replacement and additional

equipment for the current year – the Annual Purchase Activities
(APA) for equipment;
• the proposed major rehabilitation projects for the current
As a result of this prioritization
What? year – the Annual Rehabilitation Activities (ARA) for equipment;
process, determines various
• the proposed corrective actions for the current year
annual plans
(maintenance, consumables, administrative inputs, etc.) – the
Annual Corrective Activities (ACA) for equipment.
• the proposed training for the current year – the Annual Training
Activities (ATA) for equipment.
As a result, develops the

• the income and expenditure portions of the Annual Equipment
overall equipment budget
What? Budget (AEB) which will cover all capital and recurrent costs
which will be required in the
for equipment.
current year
Prints and distributes copies of

For the Health Management Team (including all heads of
the proposed APA, ARA, ACA, Why? section) so they can study and comment on them
ATA, and AEB
Updates the existing CEEP and

After the plans are finalized – Step 6 of the annual planning and
CEFP with the final decisions
When? budgeting process (see Figure 37).
for the coming year and any
implications for the long-term
202
Step 6 – Finally, when your budget has been approved by the central
health service provider, you update the EDP, ETP, CEEP, and
CEFP with the final agreed Annual Plans and Budgets
Use the process shown in Figure 37, having considered the following issues.
Of course, your health service provider may not have provided you with all the funds
requested. In this case, you will have to undertake another round of prioritization
using the principles discussed under Step 5. We recognize that there may also be
problems with the flow of money and the time it arrives at each health facility
(Section 8.2).
Figure 37: Updating All Long-term Plans and Budgets with the Final Agreed and Financed
Annual Actions
HTM Working Group (or its various sub-groups):
Ensures it remembers to
update all the long-term plans After the Budget has been approved by the health service
when the final decisions for the When? provider at a time determined by them (see Annual Calendar in
coming year are approved Figure 31).
To determine:
Studies the Budget provided
Why? • what changes or cuts have been imposed
by the health service provider
• which actions can be financed in the coming year.
According to:
• the overall goals in the long-term Equipment Development
Plan (EDP), Equipment Training Plan (ETP), and Core
If the annual needs have been Equipment Expenditure Plan (CEEP);
cut, prioritizes the requirements • the principles of the purchasing, donations, replacement, and
across the service level as a How?
disposal policies (Section 4.4);
whole • the available finances and goals of the Core Equipment
Financing Plan (CEFP);
• how important the equipment is for clinical operations
(see Box 45).
Revises the existing annual and So that the annual and long-term plans can reflect the actions
long-term plans Why? and decisions made for the current year.
Update:
• the Annual Purchase Activities (APA), Annual Rehabilitation
Enters the final agreed Activities (ARA), Annual Corrective Activities (ACA), Annual
actions/decisions onto the Training Activities (ATA), and Annual Equipment Budget
master (computer) records for How? (AEB) – see Figure 36 – with the actions/decisions for the
the annual and long-term plans coming year;
• the EDP, ETP, CEEP, and CEFP (see Figures 33, 34 and 36)
with the actions/decisions for the coming year and any
implications for the long term.
Prints and distributes final

For the Health Management Team (including all heads of
revised copies of the APA, Why? section) so they can act on them.
ARA, ACA, ATA, and AEB
203
Once these plans are ready, other staff will need to implement the plans, as follows:
Finance Officer submits the budgetary requirements in the

Annual Equipment Budget to the central
financing body of the health service provider
Central Financing Body raises and allocates all (or part) of the funds
requested
Health Management Team on receipt of the funds:

◆ further prioritizes actions if funds are cut
◆ raises additional funds (if allowed and required to)

◆ allocates sufficient budgets to cover all the
annual work plans agreed.
Purchasing and Supplies Officer ◆ buys equipment only according to the agreed
Annual Purchase Activities
◆ liaises with the Specification Writing Group
regarding the necessary Generic Equipment
Specifications (Section 4.5), and purchase
contract details (see Guide 3)
◆ liaises with the relevant users to raise the
‘Purchase Order Requisitions’ and initiates the
normal process for purchasing (see Guide 3 for
more details on these procedures).
Box 46 provides an example of the annual action plan taken from the sample
Equipment Development Plan (see Box 38) and the sample Equipment Training
Plan (see Box 41). This assumes that the health facility concerned is large enough
to have an HTM workshop of its own and shows its needs. For smaller health
facilities, these requirements would be covered by the annual plan for the
district/regional HTM Service.
As the example shows, the actions have had to be altered because:

i. some activities will have been left over from the previous year which need
completing
ii. emergency activities may have arisen
iii. some activities can no longer be afforded.
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BOX 46: Sample Annual Action Plans for Equipment (using examples for 2005 from Boxes 38 and 41)
Plan Actions (comments on changes from the EDP and ETP)

Annual Purchase ◆ replace the casualty ECG recorder
Activities (APA) ◆ replace one instrument set for the CSSD (number reduced from original EDP)
◆ replace the dental suite
◆ purchase two foetal heart detectors (number reduced from original EDP)
◆ purchase package of material inputs for these items, as necessary
◆ purchase package of support inputs for these items, as necessary
◆ undertake pre-installation work for these items, as necessary
Annual Rehabilitation ◆ overhaul the generating set

Activities (ARA) ◆ overhaul half the beds (left over from 2004)
Annual Corrective ◆ service the automatic film processor

Activities (ACA) ◆ introduce PPM for electrical installations
◆ continue PPM for plumbing installations
◆ source and purchase red safe-light filters
◆ purchase correct X-ray developer and fixer
◆ purchase safety clothes for the maintenance workshop staff
◆ purchase maintenance report files for user department
◆ purchase maintenance record files for the workshop
Annual Training ◆ re-train clinical officers and nurses on ECG recorder use
Activities (ATA) ◆ upgrade laundry staff skills in laundry procedures
◆ re-train technicians on photometer repairs
◆ PPM training for artisans on compressors
◆ upgrade artisans’ craft certificates (left over from 2004)
Box 47 provides an example of the annual equipment budget showing the

expenditure and financing plans taken from the sample Core Equipment Expenditure
Plan (see Box 42) and the sample Core Equipment Financing Plan (see Box 43). It
continues with the examples which were shown in Box 42 and Box 43. However, as
can be seen, the figures are altered because:
i. when you prepare your annual budget your calculations are more realistic than
the original long term estimates
ii. you must cut your planned expenditure to fit your likely income.
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BOX 47: Sample Annual Equipment Budget (using examples for 2005 from Boxes 38 and 41)
Income [US$] Expenditure [US$]

(update figures with current more exact estimates) (use calculations for specific annual estimates)
Category Budget Category Budget
(comments on (comments on
changes from changes from
example CEFP) example CEFP)
Own resources Capital

Accumulated retained surplus Replacement 44,500 (cut)
from previous year 450 (less) New equipment 1,600 (cut)
Income from sale of equipment 600 (more) Installation and commissioning 3,000 (estimate too
Patient fees 1,600 (less) high)
Income generating projects 3,100 (more) Initial training 500
Pre-installation 2,000
National resources
Government grants 87,000 (less) Rehabilitation 8,900 (need more)
Government loans 550 (less) Recurrent
Donations 1,200 (more) Equipment maintenance 25,600 (need more)
Local business sponsorship 2,500 (more) Consumables 19,500 (need less)
Administration 5,500 (need less)
International resources
External support agency grants 20,000 Ongoing training 12,200 (estimate too
high)
External support agency loans 5,000
Donations 1,300 (more)
Total Income 123,300 (less) Total Expenditure 123,300 (less)
Note:
i. If at the end of the year your expenditure is less than your income, you will have a retained surplus/profit for use
in the following year (if you are allowed to keep it and do not have to return it to the central financing body such as
the treasury).
ii. If towards the end of the year your expenditure looks as though it may exceed your income, you will have to cut
your expenditure in order not to be in debt.
8.2 MONITORING PROGRESS

An important part of the management of equipment-related activities is the
identification of problems and needs. All equipment-related activities should be
monitored and evaluated, and the performance of equipment, staff, and departments
should be supervised (this applies to all clinical, technical, and support
departments). The results of such monitoring are useful for providing feedback to:
◆ staff
◆ Health Management Teams

◆ the Healthcare Technology Management Service.
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8.2 Monitoring progress
This feedback is beneficial as it enables you to learn from your actions, and
incorporate the lessons learned into the next round of planning and budgeting.
Each goal you set yourself must be easily measured, so that you can see if it has been
achieved or if progress is being made:
◆ You need a way of determining if you are moving towards your goal – this is called
an indicator. There will always be several possible indicators for each goal, and
more than one way of measuring them.
◆ You need to know where you are starting from, in other words, what the current
situation is – this is called the baseline data. The data chosen must be relevant
to the indicator.
Box 48 provides examples of different ways of measuring a goal using indicators and
baseline data. The examples use calculations that were mentioned during the
analysis part of the equipment development planning process (see Box 36 in
Section 7.1).
BOX 48: Examples of How to Measure Goals
Goal: Let’s ensure that the health service we deliver is not deteriorating
An indicator: Increase the number of equipment items on the inventory which are replaced at
the end of their useful life
Calculation required:
Percentage of items on your Equipment Inventory which are within their expected lifespans
= Number of equipment on inventory within its expected lifespan x 100 per cent
Total number of equipment on inventory
Baseline data: You have 150 pieces of equipment on your inventory. In August, you identify that
40 of these items are so old they need replacing. Therefore, there are 110 items
within their expected lifespan.
Therefore your baseline data is 73.3 per cent.
Your aim is to improve this situation and increase this percentage.
Goal: Let’s have as much equipment as possible in a working condition

An indicator: Increase the completion of outstanding equipment repairs and renovations
Percentage of your Equipment Inventory which has been returned to working order
= Number of equipment on inventory in working order x 100 per cent
Total number of equipment on inventory which could be in working order
Baseline data: You have 150 pieces of equipment on your inventory. In August, you identify that
only 110 of these are within their expected lifespan and could be in working order.
However, you find only 75 in working order.
Therefore your baseline data is 68 per cent.
Your aim is to improve this situation and return an additional 10 items to working
order by the end of December.
Continued overleaf
207
BOX 48: Examples of How to Measure Goals (continued)
Goal: Let’s ensure we have enough equipment to offer basic health services
An indicator: Decrease the shortfall of equipment
Percentage of your Model Equipment List available on your Equipment Inventory
= Number of items on Model Equipment List missing from your Inventory x 100 per cent
Number of equipment items on Model Equipment List
Baseline data: Your Model Equipment List contains 200 items. You find that 50 of these are not
on your Equipment Inventory.
Therefore, your baseline data is 25 per cent – i.e. a quarter of the model list is missing.
Your aim is to improve this situation and decrease this percentage.
It will be necessary to choose suitable indicators that are specific to all your annual
goals. There are many possible indicators for planning and budgeting, so HTM staff
and managers should look for the most important activities (or statistics and results)
to measure. Some examples of the types of indicators which can be used for
equipment planning and budgeting are those describing:
◆ the existing situation - numbers of generic equipment specifications available
- a vision available for each service level
- an equipment inventory established
◆ improved performance - the budget set meets the equipment needs
- income raised meets expenditure requirements
◆ cost-effectiveness - enough equipment is available so that it is possible to
manage/treat a significant number of patients
satisfactorily
- the right equipment is available to significantly reduce
other expenses such as length of hospital stay, need for
referrals to a more expensive higher level facility,
expensive personnel or expensive drugs
- equipment is specified which is not too dependent on
foreign skills for spare parts and maintenance.
The HTM Teams, HTM Working Groups, and Health Management Teams should
meet to agree on a few suitable indicators that can be measured easily and quickly (if
possible). Positive indicators are preferable as they motivate staff. Sometimes it is
useful to use common indicators for different teams, groups, and staff, so that their
progress can be compared.
208
Once the indicators have been agreed, they will need regular measuring and charting.
It is necessary for the relevant Health Management Team to decide:
◆ how records of these indicators will be kept (for example, whether in a register,
with a form, or on a chart)

◆ who will be responsible for keeping them
◆ how regularly the results will be summarized (for example, every quarter)
◆ what form of charts and displays will be used to show the quarterly summarized
results (so that it is easy for people to see how they are progressing).
Monitoring progress involves a number of different activities. In this Section, the

monitoring activities described are:
◆ monitoring progress with the activities in the annual equipment plans and
budgets which were set in Section 8.1 (Section 8.2.1)
◆ monitoring progress in general with your planning and budgeting activities
(Section 8.2.2).
Who is Responsible for Monitoring Progress?

- Health Management Team Are responsible for monitoring progress with
- HTM Working Group equipment-related activities
- HTM Team
Every service level Needs to monitor progress
8.2.1 How to Monitor Progress Against Annual Equipment

Plans and Budgets
Monitoring progress against goals is one of the best ways that staff, managers, and
the health service provider can judge their work performance. Thus, it is necessary to
follow up the goals set in the equipment plans and budgets (Section 8.1), in order to
ensure that they are put into practice. If this is not done and goals sit on a shelf
gathering dust, then all the time spent planning will have been wasted.
Several aspects of your plans and budgets need to be monitored, and are discussed in
this section. These include:
◆ which parts of the plans were implemented
◆ which incomes and expenditures were not properly forecast

◆ the deviations between planned expenditure and actual expenditure
◆ the consequences for future plans and budgets.
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8.2.1 How to monitor progress against annual equipment plans and budgets
Also, we cover a number of issues which arise and indicate that planning can be
improved, such as:
◆ emergency purchases
◆ maintenance contingencies
◆ consumable contingencies.
Monitoring Implementation of Plans

Over the twelve months following planning and budgeting, the Health Management
Team and its HTM Working Group should ensure that:
◆ the finances requested in the Annual Equipment Budget are raised and allocated
◆ the equipment identified in the Annual Purchase Activities are purchased and
commissioned
◆ the major rehabilitation projects planned in the Annual Rehabilitation Activities
are completed
◆ the corrective actions listed in the Annual Corrective Activities are taken
◆ the training courses planned in the Annual Training Activities are implemented.
There are usually set times when facilities review budget allocations and can
purchase items. These may occur monthly, quarterly, or even annually for large
capital items. Thus:
◆ For equipment purchases and those equipment-related consumable items which
are not commonly used (in other words, ‘non-stockable’ items in the Stores
system – Section 3.4), the relevant Heads of Department/HTM Managers apply
for their needs according to the agreed plans by completing a ‘Supplies Order
Form’ (see Guides 4 and 5).
◆ For equipment-related consumable items which are commonly used (in other
words, ‘stockable’ items in the Stores system – Section 3.4), the Stores Controller
automatically applies for the departmental/workshop needs on their behalf.
◆ For expenditures which require assistance from external sources (such as
maintenance support or training courses), the relevant Department Head/HTM
Manager obtains quotes for the work according to the agreed plans.
The Purchasing and Supplies Officer will follow the normal procurement procedures
(see Guide 3) for:
◆ obtaining proforma invoices
◆ scheduling Tender Committee meetings

◆ choosing the suppliers to be used
◆ placing orders.
210
Occasionally, problems can arise if the central financing body incurs delays obtaining
foreign currency or with cash flow. In such cases, your service level may not always
get all the agreed elements of the budget requested, or may not receive funds on
time. You may therefore be forced to revise your budget (and plans) constantly
throughout the year.
Experience in a Southern Asian Country

◆ The government treasury imposed a general embargo for all ministries (including
Health) on new construction and the purchase of office equipment for the first six
months of 2001.
◆ As their financial year runs from January to December, the tenders could not be
advertized and processed until the second half of the year.
◆ Thus unfortunately, by the time the tenders could be awarded, the financial allocations
for that year had already lapsed.
Emergency Purchases
As Section 7.1 says, all capital expenditure should be covered by the Equipment
Development Plan (EDP), and the planned purchases should be procured according
to the normal procedures which are covered in Guide 3. However, in some cases
there may be emergency requirements that departments legitimately need outside
the planned Annual Purchase Activities (Section 8.1). These often arise during the
year due to circumstances that could not be foreseen.
Emergency purchases are not planned and lead to deviations between planned and
actual expenditures. If there are too many deviations of this kind, it indicates that
planning should be improved.
If emergency purchases are requested during the year, you need to take steps to alter
your annual plans and budgets, as shown in Box 49.
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BOX 49: Procedures for Emergency Equipment Purchase Requirements
1. Heads of Department:
◆ When emergency equipment needs arise outside the planned Annual Purchase Activities (Section 8.1),
submit their requirements (details, estimated costs, and reasons) to the HTM Working Group.
2. HTM Working Group:

◆ Meets to:
- review the submissions
- discuss the implications of the proposals
- and either approve them, reject them, or return them for further information.
◆ Submits approved proposals to alter the Annual Purchase Activities to the Health Management Team,
who can grant approval if funds are available.
3. Heads of Department:
◆ If the changes are agreed, liaise with the Purchasing and Supplies Officer regarding ‘Purchase Order
Requisitions’ and the normal process for procurement (see further details in Guide 3).
Maintenance Contingencies
The HTM Team will have estimated their annual maintenance needs according to
Figure 21, as part of the Annual Corrective Activities (Section 8.1). In addition,
they will have determined monthly estimates within the annual plans (Section 6.1).
However, contingencies can arise over time which are difficult to plan for, such as
sudden crisis breakdowns of serviceable items.
Maintenance contingencies are not planned and lead to deviations between planned
and actual expenditures. If there are too many deviations of this kind, it indicates
that planning should be improved.
If maintenance contingencies arise, you need to take steps to alter your annual plans
and budgets, as shown in Box 50.
BOX 50: Procedures for Maintenance Contingencies
HTM Manager:
◆ When maintenance needs arise outside those planned:
Either – submits the contingency cost for inclusion in the following month’s maintenance budget
(Section 6.1)
Or – puts in a request for contingency funds outside of the existing maintenance budget.

◆ Considers proposals to alter the Annual Funding Plan and grants approval if the funds are available.
◆ If the changes are agreed, informs the Finance Officer and the HTM Manager.
212
Consumable Contingencies
The Heads of Department will have estimated their annual equipment-related
consumable needs according to Figure 22, as part of the ‘Annual Corrective Activities’
(Section 8.1). In addition, they will determine monthly estimates within the annual
plans (Section 6.2). However, contingencies can arise over time which were difficult
to plan for, such as unexpected surges in workload, outbreaks, and epidemics.
Consumable contingencies are not planned and lead to deviations between planned
and actual expenditures. If there are too many deviations of this kind, it indicates
that planning should be improved.
If consumable contingencies arise, you need to take steps to alter your annual plans
and budgets, as shown in Box 51.
BOX 51: Procedures for Consumable Contingencies
Heads of Department:
◆ When equipment-related consumable needs arise outside those planned:
Either – submits the contingency cost for inclusion in the following month’s departmental budget
(Section 6.2)
Or – requests for contingency funds outside the existing departmental budget.

◆ Considers proposals to alter the Annual Funding Plan and grants approval if the funds are available.
◆ If the changes are agreed, informs the Finance Officer and the Head of Department.
Monitoring Expenditure against Allocations

When funds are allocated, it is necessary to show how they are actually spent. This
requires you to monitor actual expenditure against allocation, and is often
undertaken on a monthly basis.
All Heads of Department and the HTM Manager have a role to play, together with
the Finance Officer. By monitoring expenditure against allocation, it is possible to
learn whether expenditures were properly forecast, thus enabling you to improve
upon your planning and budgeting the next time around.
Information concerning how allocated funds are actually spent should be available at
all levels, as feedback.
Box 52 shows you what steps to take.
213
BOX 52: Procedures for Monitoring Expenditure against Allocations
HTM Manager and Heads of Department:

◆ monitor their actual recurrent expenditure against their allocations on a monthly basis
◆ keep a record of how the current month’s allocation is being spent, according to the formal financial
reporting requirements
◆ follow all accounting guidelines (such as the submission of receipts to the Finance Officer on all
purchases arising from allocated funds)
◆ make estimates for the next month’s expenditure (Sections 6.1 and 6.2).
Finance Officer:
◆ compiles the data on expenditure against allocations and the next month’s estimates, for all of the
departments
◆ submits a written Financial Report to the Health Management Team for the monthly budget meeting
◆ provides the information on how funds allocated are actually spent as feedback to all levels.
Reaching Performance Targets

Each facility and service level should have goals and plans which set out their priority
activities for all health service work (Section 8.1). The normal departmental annual
action planning process (see Guides 4 and 5) will mean that goals are set for each
department regarding their daily work. They will also have indicators to measure
whether they reach their performance targets.
At the end of the year, it is essential to review and carefully analyze the results
achieved on all the departmental goals that have been set.
Once planning and financial systems are established, it might be possible to link
departmental annual planning to the process of setting their departmental budgets.
The achievement of proposed targets by a department could then play an important
part in justifying the budget allocations it requests from senior management.
For example, the Health Management Team can consider:

◆ the achievement by the HTM Team of its targets, when determining the budget
allocation for maintenance

◆ achievement by user departments of their targets, when determining their
recurrent budget allocations
◆ the achievement by the equipment training sub-group of their proposed training
targets, when justifying the budget allocations for training.
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8.2.2 How to monitor progress in general
8.2.2 How To Monitor Progress in General

Regular monitoring of activities and services is also essential for improving the
quality of healthcare. Management need facts so that they can plan effectively, and
need to know how equipment-related activities are performed. Thus it is important
that you have some method of collecting information.
The people and groups involved in planning and budgeting need to gather
information regularly on the progress of their teams, and their work performance.
Such information will not only enable all those involved to manage their teams more
effectively, it also provides an important source of feedback for other people and
bodies who need to know how they are functioning.
Therefore health planners, finance officers, and HTM Working Groups and other
bodies involved in planning need to:
◆ monitor their progress with establishing the planning and budgeting ‘tools’
◆ ensure they keep active tools up-to-date

◆ ensure that the information generated by such tools is used to improve activities
such as stock control, training and procurement
◆ study the implications arising from planning and budgeting.
Establishing the Planning and Budgeting Tools

Box 53 shows the steps to take to ensure that planning and budgeting work is
implemented.
BOX 53: Monitoring the Establishment of Tools
Health Management Team and its HTM Working Group:

◆ Monitors progress with establishing the:
- Equipment Inventory (Section 3.1)
- equipment stock value estimates and a Reference Equipment Price List (Section 3.2)
- budget lines for equipment expenditures (Section 3.3)
- usage rates for equipment-related consumable items (Section 3.4)
- reference materials (Section 4.1)
- Vision (Section 4.2)
- Model Equipment List (Section 4.3)
- Purchasing, Donations, Replacement, and Disposal Policies (Section 4.4)
- Generic Equipment Specifications, and the environmental and technical data sheet (Section 4.5).
◆ Monitors that all the budgeting tools for capital and recurrent expenditure are understood and used
(Sections 5 and 6).
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8.2.2 How to monitor progress in general
Keeping Tools Up-to-Date

The HTM Working Group (or its pricing sub-group) needs to:
◆ revise the Reference Equipment Price List regularly in order to ensure that an up-
to-date database of current equipment prices is available (Section 3.2)
◆ revise the equipment stock values periodically (see Figure 8)
◆ annually review the usage rates and requirements for equipment-related
consumable items (see Figure 10)
◆ annually update the library of reference materials and subscriptions (see Box 12).
Providing Feedback to Improve Procurement and Stock Control

The HTM Working Group (or its pricing sub-group) needs to use the data from the
Usage Rate planning tool (Section 3.4) to ensure that:
◆ correct information regarding the requirements and usage rates for equipment-
related consumable items is provided to the Stores Controller, for better
calculation of reordering quantities and times
◆ those items which are commonly used become ‘stockable’ items in the Stores system
◆ correct information regarding problems with equipment and its related supplies are
provided to the Specification Writing Group and Tender Committee (Section 1.2),
for more appropriate selection of models during procurement (see Guide 3).
Providing Feedback to Improve Training

During the planning process various prompts that training is required will emerge,
due to:
◆ the analysis of the equipment inventory, the Equipment Development Plan, and
the Equipment Training Plan
◆ the equipment purchases planned.
Figure 26 provides examples of the types of prompts. These should be passed onto
the Human Resources Department.
Implications of Planning and Budgeting

The (central level) Health Management Team needs to analyze the implications arising
out of planning and budgeting. For example, they could use the data to determine:
◆ life-cycle costs of equipment
◆ costs per intervention (unit costs), and whether the interventions are economic
◆ the percentage of expenditure used against different equipment budget lines.
216
Section 8 summary
The (central level) Health Management Team needs to monitor the planning and
budgeting process in order to identify any implications. For example, they could
monitor:
◆ the correct utilization of budget lines (for example, has money previously earmarked
for maintenance been moved and used for food, fuel or other commodities?)
◆ whether decentralized control of budgets is working (for example, do the
decentralized authorities leave vital activities unfinanced?).
BOX 54: Summary of Procedures in Section 8 on Setting Annual Goals and

Monitoring Progress
HTM Teams ◆ update the Equipment Inventory according to Figure 32
HTM Working ◆ review the Equipment Development Plan and Equipment Training Plan for annual
Groups (or needs according to Figures 33 and 34
their various ◆ cost the proposals for the coming year according to Figure 35
sub-groups)
◆ review the Core Equipment Expenditure Plan and Core Equipment Financing
Annual Plans
Plan, prioritize the allocation of funds, and prepare proposals for:

- Annual Purchase Activities
- Annual Rehabilitation Activities
- Annual Corrective Activities
- Annual Training Activities
- Annual Equipment Budget, according to Figure 36.
◆ update all long-term plans and budgets with the final agreed and financed annual
actions, according to Figure 37.
Health ◆ raise the funds required

Management ◆ allocate sufficient funds for the action planned
Teams
HTM Working ◆ monitor progress with:

Groups (or - implementing the annual plans
Monitor Progress
their various - expenditure against allocations according to Box 52

sub-groups) - establishing the ‘tools’, according to Box 53
◆ react to emergencies and contingencies outside of the plans, according to
Boxes 49–51
◆ keep the planning and budgeting tools up-to-date
◆ provide feedback to improve procurement, stock control, and training
Health ◆ consider the achievement by departments and groups in reaching performance

Management targets, when determining their budget allocations
Team ◆ consider the implications of the data arising out of planning and budgeting
Tip • Remember – if you have not been able to develop all the tools and plans because you
are short of management skills, Annex 6 contains bare minimum requirements for
equipment planning and budgeting for people who are just starting out.
217
218
Annex1: Glossary
ANNEX 1: GLOSSARY
Acceptance process: Activities undertaken when equipment arrives at an health facility, at
the end of which the equipment will be operational and officially belong
to the facility, such as receipt, unpacking, installing, commissioning,
initial training, entering into Stores and onto records, payment.
Accessories: For equipment, those items which connect the machine to the patient
(e.g. leads, probes), assist with the use of the machine (e.g. trays, foot-
switches), or adapt its performance (e.g. adaptors, lenses).
Acquisition: To obtain equipment through both procurement and donations.
Administrative level: See decentralized authorities.
Allocation: In financial terms, the funds distributed to a unit within an
organization to be spent for a particular purpose.
Assets: All resources owned by an organization, for example money,
equipment, land.
Autonomous: Self-governing or independent.
Budget: A written financial plan listing future, known, or estimated income
and expenditure covering a given period of time, such as a year
(annual budget).
Capital budget: Planned expenditure on capital items (such as buildings, equipment,
vehicles) that require substantial (possibly one-off) payments in a year,
and should not be included in the recurrent (or operational) budget.
Central level: Highest authority of your health service provider, such as Ministry of
Health or Board.
Commissioning: A series of tests and adjustments performed to check whether, and
ensure that, new equipment is functioning correctly and safely before
being used.
Communication equipment: Any equipment that is used for sending or receiving information, such
as telephones, two-way radios, nurse-call systems, paging systems.
Consumables: For equipment, those items which are used up during the operation of
equipment (e.g. film, reagents, gel).
Contingency: An event in the future that may happen but is not guaranteed to
happen; an amount set aside in the budget for contingencies is a
reserve for unexpected expenditure.
Cost centre: A unit of an organization that generates expenses but has no
responsibility for generating revenue (income); its goal is to adhere
to expense budgets, which are tailored to meet certain objectives
Which type of unit (health authority, facility, division, or department)
acts as a cost centre depends on whether it is at a level that has the
independence and responsibility to be allocated money, spend it, and
account for the expenditure.
Decentralized authorities: Local units of an organization that have had authority transferred to
them from the central level of the organization. For example, district,
regional, provincial or diocesan health authorities.
219
Annex1: Glossary
Decommission: Take out of service; dismantle and make safe; board. The process of
condemning or writing off equipment and disposing of it.
Depreciation: The amount by which the monetary value of an asset is reduced over a
period of time due to its everyday use (‘wear and tear’) or due to the
fact that it could not be sold second hand for as much as it originally
cost; the asset is said to depreciate in value.
Donor: See external support agency.
Energy sources: A source of energy or power, such as generating sets, solar panels
or transformers.
Equipment-related supplies: Items which are essential for equipment use, such as consumables,
accessories, spare parts, and maintenance materials used
with equipment.
Equipment users: All staff involved in use of equipment, such as clinical staff (e.g.
doctors and nurses), paramedical staff (such as radiographers and
physiotherapists) and support services' staff (such as laundry and
kitchen workers).
Essential service package: Definitions developed by health service providers of the basic service
packages to be offered at each level of healthcare delivery, in terms of
healthcare interventions. From these interventions, human resource,
space, and equipment requirements can be determined.
Expenditure: The amount of money spent (or due to be spent) by a unit within an
organization; payments made out of a financial allocation provided for
a particular purpose; money spent from your income.
External support agency: A body responsible for providing money, equipment, or technical
support to developing countries on various terms, such as
international donors, technical agencies of foreign governments,
non-governmental organizations, private institutions, financial
institutions, faith organizations.
External support agency staff: People working for external support agencies that health workers come
into contact with, such as a country representative, desk officer,
consultant, coordinating agency, director.
Fabric of the building: Items which are part of the integral structure or framework of a
building, such as doors, windows or roof.
Facility: See health facility.
Financial year: Period over which a set of accounts operate; the date up to which the
annual accounts of an organization are prepared (not necessarily the
calendar year).
Fire fighting equipment: Equipment used to put out fires, such as fire blankets, buckets,
extinguishers, hose and sprinkler systems.
Fixtures built into Items which are not part of the integral structure of a building but are
the building: installed into the fabric of the building, such as ceiling-mounted
operating theatre lights, scrub-up sinks and fume cupboards.
Head of section: Departmental manager, such as head of department, group leader,
officer in-charge, senior operator.
220
Annex1: Glossary
Health facility: Buildings where healthcare is delivered, ranging from small units
(clinics, health centres), and small hospitals (rural, district, diocesan),
to large hospitals (regional, referral).
Health facility furniture: Furniture with a specific clinical use in health facilities, such as beds,
cots, trolleys, infusion stands.
Health management team: Health management body, such as facility management committee,
district/regional/diocesan/central health management team, Board.
Health service provider: A provider of health services, such as Ministry of Health or Defence,
non-governmental organization, private institution, employer
organization or corporation (for example, mine), faith organization.
Health system: Comprises all organizations, institutions, and resources devoted to
health actions (defined as any effort, in personal or public health
services or through intersectoral action), whose primary purpose is to
improve people’s health (Source: WHO).
HTM Manager: Head of the HTM Team; ranging from a general member of health
staff with some management skills in the smallest HTM Teams, to an
engineering manager in the highest level of HTM Team.
HTMS: Healthcare Technology Management Service made up of a network of
HTM Teams and HTM Working Groups.
HTM Team: A body responsible for the management of equipment, such as,
equipment management team, maintenance management team,
physical assets management team; part of the HTM Service.
HTM Working Group: A working group, or standing committee responsible for making
decisions on healthcare technology management issues; part of the
HTM Service.
Income: Money received, usually generating from work done or investments
made; revenue.
In-house: Activities undertaken by staff already employed by the health service
provider organization (rather than using temporary hired labour or
external contractors).
Installation: The process of fixing equipment into place; can range from building
equipment into the fabric of a room, to simply plugging it into an
electrical socket.
Inventory: A systematic listing of stock (or assets) held. An annual inventory is
prepared at the end of each year following a physical inspection and
count of all items owned by an organization. The list gives details,
such as location, reference number, description, condition, cost, and
the date the inventory was taken.
Laundry and kitchen Equipment required for kitchen or laundry activities, such as cookers,
equipment: cold rooms, washing machines, hydro-extractors, roller-ironers.
Life-cycle costs: The recurrent cost required to keep equipment going throughout its
life (e.g. fuel, consumables, maintenance, training, disposal).
Lifetime: Lifespan, life expectancy. For equipment, the likely length of time
that an item will work effectively, dependent on the type of
technology and parts used in its manufacture.
221
Annex1: Glossary
Maintainers: See maintenance staff.

Maintenance materials: Those items used up during the maintenance of equipment, and
generally available from many sources (e.g. washers, oil, fuses, paint).
Maintenance staff: Staff responsible for maintenance of equipment, such as craftspeople,
artisans, technicians, technologists, engineers.
Manager: Any staff involved in the management of equipment-related activities.
This could include administrator, nurse-in-charge, medical
superintendent, chief executive, director, health secretary, medical
practitioner, maintenance manager, policy-maker.
Medical equipment: Equipment used for medical purposes, including X-ray units,
diathermy units, suction pumps, foetal doppler, scales, autoclaves,
infant incubators, centrifuges.
Model Equipment List: A list of the essential equipment for a health service level/facility type
(rural, district, regional, referral), determined by considering each
necessary healthcare intervention (function, activity, or procedure) for
example, equipment required for eye-testing, delivering twins,
undertaking fluoroscopic examinations, testing blood for malaria.
Office equipment: Equipment used in an office, such as computers, photocopiers,
calculators, record systems.
Office furniture: Furniture used in an office, such as desks, chairs or filing cabinets.
Plant, general: Machinery such as boilers, lifts, air-conditioners, water pumps
or compressors.
Pre-installation work: Activities required in preparation for the arrival and commissioning of
equipment, such as preparing the site at the health facility so the
equipment can be installed, hiring lifting equipment, organizing or
hiring warehousing space.
Profit centre: A unit of an organization that generates both revenue and expenses; its
goal is to have revenue exceed expenses.
Quality control: A system of maintaining standards; testing a sample
against specifications.
Recurrent budget: Planned expenditure on recurrent items for ongoing monthly needs,
such as drugs, materials, spare parts, food, fuel, which should not be
included in the capital budget.
Rehabilitate: Restore to a former state; renovate; undertake major repair work to
return an item to a working condition.
Service supply installations: Supply installations such as electrical installations, water and sewage
pipelines, gas supplies.
Spare parts: For equipment, those items which make up the machine, need
replacing as they wear out, and may be specific to a particular model
(e.g. bearings, bulbs, printed circuit boards).
Specifications: A detailed description of the design and materials used to make
something; a standard of workmanship, materials, etc. required to be
met in a piece of work. Generic specifications refer to a class or type
of thing and do not specifically mention a brand name.
222
Annex1: Glossary
Standard: A required or agreed level of quality attainment set by a recognized

authority, used as a measure, norm, or model for all aspects of health
services and healthcare technology.
Standardization: Rationalization, normalization, and harmonization. In other words,
reducing the range of makes and models of equipment available in
stock, by purchasing particular or named makes and models.
Stock: In stores, this is the goods held by an organization for its own use. The
‘equipment stock’ is all the equipment assets owned by an organization.
Supplier: Someone who provides equipment, such as a manufacturer,
manufacturer’s representative, wholesaler, salesman.
Support staff: Additional types of staff in the health service besides medical
personnel, such as planner, finance officer, procurement officer, stores
controller, human resource officer.
Training equipment: Equipment required when running training courses, such as overhead
and slide projectors, video and tape recorders.
Users: See equipment users.
Vehicles: Any conveyance used for transporting people, goods, or supplies in the
health service, such as ambulances, cold-chain motorbikes, mobile
workshops, lorries, buses.
Walking aids: Items used to aid mobility, such as wheelchairs, zimmer frames, crutches.
Waste treatment plant: Any plant used to treat waste, including incinerators, septic tanks or
biogas units.
Working group A group of people set up to be responsible for a particular subject area,
such as a standing committee, select committee, sub-committee.
Workshop equipment: Equipment used in a workshop, such as hand tools, bench tools or
test instruments.
Your organization: See health service provider.
BOX 54: WHO’s Definition of the Technology Management Hierarchy

Equipment support: undertaking maintenance and repair.
Equipment management: using the equipment database (inventory and maintenance history)
to help you make decisions for improving equipment support.
Asset management: including cost and utilization information (life-cycle cost analysis) in
the equipment database to help you make decisions on replacement
and acquisition.
Technology assessment: reviewing past, current, and future technologies to determine their
efficacy and effectiveness, and to help you make decisions for capital
planning and acquisition.
Technology management: using: equipment
equipment support
equipment management
asset management
technology assessment
to manage technology in health care from conception to retirement.
Source: Department of Health Service Provision, World Health Organization, 2000
223
Annex 2: Reference materials and contacts
ANNEX 2: REFERENCE MATERIAL AND CONTACTS

This Annex is in two parts, and provides information about:
Part i. Books, guidelines, databases, and websites
Part ii. Organizations, sources of publications in part i, resource and information centres.
i. Books, Guidelines, Databases, and Websites

The following books, guidelines, databases, and websites are listed in subject categories according to
the topics found in Sections of this Guide. For each publication, a brief description of the content and
the main source(s) are included. Contact details for the source organizations are included in Part ii.
Readers should note that many of the publications are available at low cost. In some countries it may
also be possible to obtain these publications from local bookstores, as publishers and distributors
increase efforts to ensure wider availability. Published prices may be flexible depending on the order
size, discounts available and distribution method.
Tip • Many books and documents cover a variety of topics that appear in several Sections of this Guide. The
first time they appear in this list they are described in full. For each subsequent entry only the basic
details are provided.
Healthcare Technology Management Framework Issues

This material covers issues in Sections 1 and 2, such as healthcare technology management
definitions, policy, regulations, guidance, and services, and in Section 4.4 on developing purchasing,
donations, replacement, and disposal policies. It is listed alphabetically by title.
Developing healthcare technology policy

Examples of Policies
A number of health service providers have already developed their own healthcare technology policies, as
well as implementation guidelines to go with them. For example, more information can be obtained from:
◆ Dr P Asman, Biomedical Engineering Unit, Ministry of Health (Room 33, MOH Building), PO
Box M-44, Accra, Ghana. Email: nchtm@africaonline.com.gh
◆ Ministry of Health, PO Box 7272, Kampala, Uganda. Email: info@health.go.ug, website:
www.health.go.ug/support_system.htm
◆ Dr N Forster, Under Secretary: Health and Social Welfare Policy, Ministry of Health and Social
Services, Private Bag 13198, Windhoek, Namibia. Email: nforster@mhss.gov.na
◆ Director of Health, Lusaka Urban District Health Board, PO Box 50827, Makishi Road, Lusaka,
Zambia. Email: msinkala@lycos.com
◆ Department of Hospital Services, Ministry of Health, 151-153 Kampuchea Krom Boulevard,
Phnom Penh, Kingdom of Cambodia. Email: procure.pcu@bigpond.com.kh, website:
www.moh.gov.kh
224
Health care technology management No.1: Health care technology policy framework
Kwankam Y, Heimann P, El-Nageh M, and M Belhocine (2001). WHO Regional Publications, Eastern
Mediterranean Series 24. ISBN: 92 9021 280 2
This booklet is the first in a series of four titles. It introduces the ideas of and behind health care
technology management, defines terms relating to and sets objectives for health care technology
management policy. It examines what should go in to such a policy, and the national policy framework
and organization. Capacity-building and human resources issues are considered, as well as economic
and financial implications. Attention is also given to legislation, safety issues, cooperation nationally
and between countries, implementation, monitoring, and evaluation. See Guide 1 for information on
the three further titles in this Series:
No.2: Eastern mediterranean regional strategy for appropriate health care technology
No.3: Health care technology policy formulation and implementation
No.4: Country situation analysis.
Available from: WHO
Interregional meeting on the maintenance and repair of health care equipment: Nicosia,
Cyprus, 24-28 November 1986
WHO (1987). WHO document WHO/SHS/NHP/87.5
This document provides a comprehensive discussion of the problem of non-functioning equipment
and of proposed solutions. The major policies, recommendations, and strategies proposed by the
conference on the issue of maintenance and repair of health care equipment are presented. It
includes four Working Papers which cover in detail: maintenance and management of equipment, the
proposed health care technical service, manpower development, and training.
Available from: WHO
Management of equipment
DHSS, UK (1982). Health Equipment Information No. 98
The aim of this booklet is to recommend a system of equipment management that, if fully
implemented, would ensure that all equipment used in the British National Health Service was
suitable for its purpose, was maintained in a safe and reliable condition, and was understood by its
users. Its recommendations and procedures are structured into sections on equipment selection,
acceptance procedures, training, servicing (maintenance, repair, and modification), and replacement
policy. It also covers the management of inventories, equipment on loan, servicing, long-term
commercial contracts, infection hazards.
Available from: Her Majesty’s Stationery Office (HMSO).
Medical equipment in sub-saharan Africa: A framework for policy formulation
Bloom, G and C Temple-Bird. (1988). IDS Research Report Rr19, and WHO publication
WHO/SHS/NHP/90.7. ISBN: 0 903354 79 9
This book provides a good overview of the situation of medical equipment in Africa. Its approach to
the analysis is to unpackage medical equipment technology into its component activities, such as
planning, allocating resources, procurement, commissioning, operation, maintenance, training, etc. It
provides good general policy formulation strategies to address the problems discussed.
Available from: WHO
Practical steps for developing health care technology policy: A manual for policy-makers
and health service managers in developing countries
Temple-Bird, C (2000). Institute of Development Studies, University of Sussex, UK. ISBN: 1 85864 291 4
This book is a practical step-by-step guide for developing health care technology policy. It can be used
by health service providers, regional and district health authorities, health facility managers, and
external support agencies. It describes a process for developing health care technology policy which is
collaborative, participatory, iterative, and involves community stakeholders. Guidance is provided on
underlying management concepts, undertaking a situation analysis, running a ideas workshop,
formulating policy, developing an implementation plan and procedures manual, as well as the
resources required to complete these tasks.
Available from: Ziken International Consultants Ltd
225
Strategic medical technology planning and policy development

Raab M (1999). Swiss Centre for International Health. August 1999.
This paper discusses the challenge of the fast expansion in technologies, and the choices that have to
be made to manage them. It looks at healthcare technology assessment, the elements and formulation
of a healthcare technology policy, and the strategic planning process required.
Available from: SCIH
See Guide 4 for resources that discuss policies for disposing of healthcare waste and the development
of a waste management plan.
Regulating relationships with external support agencies that provide equipment

Guidelines for health care equipment donations
WHO (1997). WHO document WHO/ARA/97.3
This document presents guidelines that aim to improve the quality of equipment donations, not to
hinder them. They are not an international regulation, but intended to serve as a basis for national or
institutional guidelines, to be reviewed, adapted and implemented by governments and organizations
dealing with health care equipment donations. They provide detailed guidance and checklists for
both the potential donor and recipient. The guidelines are based on extensive field experience and
consultations with many experts internationally. They also merge together several earlier documents,
including the one listed below.
Available from: WHO
Guidelines on medical equipment donations
Churches’ Action for Health (1994). World Council of Churches’ publication
This paper is a guide for those accepting and making donations, and is also useful for those planning
to buy equipment. It clearly lays out in point form the responsibilities of the recipient and the
responsibilities of the donor.
Available from: WCC
Understanding healthcare technology management

International seminar for hospital technicians/engineers: February 1998, Moshi, Tanzania
Clauss J (ed) (1998). FAKT
This document reports the results of intensive work by 38 national and international experts brought
together from faith, public, and private agencies to strengthen equipment management measures in
the health sector. It includes papers, with country examples, on healthcare technology management,
using cost-sharing to finance maintenance, networking, structures of health care technical services,
cash control for workshops, training, communication technologies, modification of medical and
hospital equipment, energy supply and photovoltaics. There are also lists of standardized equipment
for the Evangelical Lutheran Church of Tanzania and the Joint Medical Stores of Uganda, and a
description of how they were developed.
Available from: FAKT
International workshop on healthcare technology management: 2-6 October 2000,
Catholic Pastoral Centre, Bamenda, Cameroon
Clauss, J (compiler) (2000). FAKT
This document reports the results of intensive work by 35 national and international experts involved
in setting up and operating systems for the sustainable management of healthcare technology. It
includes papers, with country examples, on healthcare technology management, the role of
stakeholders, public/private partnerships for providing HTM, financial management of maintenance
organizations, and donations of healthcare technology.
226
Medical equipment in Botswana: A framework for management development

Temple-Bird C L, Mhiti R, and G H Bloom (1995), WHO publication WHO/SHS/NHP/95.1
This book reports on the results of a study of the healthcare technology sector in Botswana, and the
lessons learnt are of relevance to many other countries. The study was undertaken by unpackaging the
sector into its component activities, such as planning, allocating resources, procurement,
commissioning, operation, maintenance, training, etc. In this way the book provides good general
healthcare technology management strategies to address the problems discussed. This book also
describes how technical staff obtain their basic technical qualifications either as artisans at local Trade
Testing Centres, or as technicians at the local Polytechnic, and provides an understanding of how such
systems and qualifications work.
Available from: WHO
Medical technology management
David Y, and T Judd. (1993) BioPhysical Measurement Series, SpaceLabs Medical Inc.
ISBN: 0 9627449 6 4
This book looks at the appropriate management tools needed to make technology’s role more
clinically effective and cost–effective (based on the healthcare delivery system in the USA). It focuses
on strategic technology planning principles, and how they contribute to improved patient outcomes.
It also looks at a process for technology assessment and life-cycle cost analysis. It defines many
common terms, and the role of useful committees, procedures, and forms.
Available from: SpaceLabs Medical Inc.
Physical assets management and maintenance in district health management
Halbwachs H (2000). GTZ document
This paper provides practical guidance to health workers involved in district health systems
concerning health technology - one of the critical areas in managing health service delivery at district
level. It presents the physical assets management approach, and elaborates on key strategies for
maintenance, financing, quality control, monitoring indicators, cost-benefit analysis calculations, and
a basic paper-based maintenance information system.
Available from: GTZ
The effective management of medical equipment in developing countries:
A series of five papers
Remmelzwaal B (1997). FAKT, Project Number 390
This document is aimed at the health workers, administrators, maintainers, and overseas aid workers
who are involved in medical equipment management in developing countries. It examines the
variation in performance with management of medical equipment in different countries, with the
objective of identifying successful approaches. It addresses some of the managerial issues related to
the conservation of equipment; allocation of human, financial and material resources; and acquisition
and use. It looks at the structure for the HTM Service, and the HTM cycle. It includes an example
spreadsheet layout to use as an inventory form, with various data collection codes.
See Guide 1 for more information on further relevant issues, such as health service definitions, the
place of HTM in health systems, regulations, and standards.
227
Equipment Inventories and Price Information

This material covers issues in Section 3.1 on establishing and keeping an equipment inventory, and
an inventory code numbering system, and equipment price data needed for the stock value estimates
in Section 3.2 and the cost calculations in Sections 5 and 6. It is listed alphabetically by title.
Note on inventory software: Keeping an equipment inventory is an area where simple computer
software programs can be of assistance once you have mastered a manual paper system, have a large
enough stock (several hundred items of major equipment), and can obtain sufficient training of staff.
For example:
◆ at a district hospital, any common computer database software could be used such as a
commercially available product like Access (part of Microsoft Office) or a shareware program
available on the internet free or at competitive rates
◆ for larger stocks of equipment (for example at a teaching hospital, or a centralized inventory),
where analysis of the data is required with the possibility of sorting the data according to several
selection criteria in parallel, more sophisticated software programs can be used, such as the ECRI
and PLAMAHS products listed below
◆ more information on deciding when and how to computerize your records, see the GTZ book by
Halbwachs and Miethe listed below.
Clinical engineering service departments: Establishment, scope of work and organization
Raab M (1999). Swiss Centre for International Health, Basle, Switzerland
This paper discusses the issues that prompted the evolution of clinical equipment support services,
the resources and staff required when establishing clinical engineering service departments, and their
scope of work, including details of necessary documentation and reporting using inventories and other
recorded data.
Computerizing maintenance for health care facilities in developing countries
Halbwachs H, and B Miethe (1994). GTZ, Eschborn, Germany
This book describes the documentation and analysis required if healthcare technology management is
to be undertaken effectively (such as inventory management, planned preventive maintenance
timetabling, costs analysis). It illustrates that for large stocks of equipment such work is made easier
with the aid of computers. The book goes on to describe when and how to computerize equipment and
maintenance records, including details of hardware and software requirements and products available.
It includes details of the sort of data to be collected for effective healthcare technology management.
Available from: GTZ
District laboratory practice in tropical countries (part 1)
Cheesbrough M (1998). Tropical Health Technology. ISBN:0 9507434 4 5
A valuable resource aimed at those responsible for the organization and management of district
laboratory services but can also be adapted for use by health centres. It covers selection and
procurement of laboratory equipment and supplies, including lists of requirements with brief
specifications and indicative (1997) prices. It covers parasitological tests, clinical tests and training of
personnel, as well as all types of safety issues for laboratories.
Available from: TALC, THT
Cheesbrough M (2000) Tropical Health Technology. ISBN:0 9507434 5 3
Covers microbiological, haematological and blood transfusion techniques required at district level.
Available from: TALC, THT
228
Emergency Care Research Institute (ECRI, USA) products

This organization produces a variety of products on healthcare technology. They are available as hard
copy and as software regularly renewed by subscription, with special rates for developing countries.
The data is comprehensive and primarily written for the US audience, and the software is
sophisticated. The products cover various issues, such as:
◆ HECS 4 for Windows (includes inventory management software)
◆ Health devices source book (a directory of manufacturers and distributors for the US market,
their contact details, products, and typical price ranges)
◆ Healthcare product comparison system (a reference guide for selecting equipment)
◆ ECRI spec (a database of specifications, instructions to bidders, and terms and conditions, etc)
◆ Inspection and preventive maintenance system
◆ Health devices alerts database
◆ Health technology trends newsletter
Available from: ECRI
Healthcare equipment management
Halbwachs H. (1994). pp 14-20 in Health Estate Journal, December 1994, Portsmouth UK
This paper first discusses elements of an equipment management system including selection,
inventories, user training, and maintenance services, as well as issues concerning energy, waste, and
hygiene. It discusses establishing an HTM system including the organizational structure, personnel
requirements, and costs. It also covers typical maintenance running costs for various categories of
equipment, discusses budget implications of the backlog of repairs, and the financial balance between
preventive and repair activities.
Available from: GTZ
Hospital engineering in developing countries
Dammann V, and H Pfeiff (eds) (1986). GTZ, Eschborn, Germany. ISBN: 3 88085 293 6
This is a report of a symposium held in 1983 in Giessen. It covers the constraints in developing
countries, and requirements for establishing healthcare technical services. This includes discussions
on tasks, establishing an inventory, data collection, and training of maintenance and user staff.
Available from: GTZ
Management of equipment
DHSS, UK (1982). Health Equipment Information No. 98
Medical supplies and equipment for primary health care: A practical resource for
procurement and management.
Kaur M, and S Hall (2001). ECHO International Health Services Ltd. ISBN: 0 9541799 0 0
This book is intended for health workers and those responsible for the procurement and management
of medical supplies and equipment at primary healthcare level. It covers guiding principles for
selecting supplies and equipment, provides guidelines for ordering and procurement, storage and
stock control (with brief guidance on keeping an inventory), care and maintenance, and considers
decontamination and safe disposal of medical waste. The manual also discusses the use of standard
lists as a tool for encouraging good procurement practice and includes model lists and specifications
for medical supplies and equipment required for primary health care activities in both health facilities
in the community, and basic laboratory facilities.
Available from: TALC
229
Physical asset planning and management software (PLAMAHS)

HEART Consultancy
This software package holds information, and supports analysis, on: the equipment inventory,
equipment models and standards, existing and planned facilities, procurement support, and
maintenance support. The software holds various digital images, model equipment lists,
specifications, price and other financial data, and templates for forms, etc., and has a security system.
It has been designed especially with developing countries in mind and is available at special rates for
developing countries. It is being used in a number of countries, and HEART can assist with the set up
and initial training requirements.
Available from: HEART Consultancy
Practical laboratory manual for health centres in East Africa,
Carter J and Olema O (1998). AMREF.
Practical laboratory manual providing information necessary to establish, select and use laboratory
tests for patient management. Also includes material on implementation of safe working practices,
reporting and recording test results, keeping an inventory of supplies and equipment, ordering
supplies and maintaining equipment.
Available from: AMREF
Spare parts and working materials for the maintenance and repair of health care
equipment: Report of workshop held in Lübeck, August 1991
Halbwachs H, and C Temple-Bird (eds) (1991). GTZ, Eschborn, Germany
This book, mainly aimed at maintenance technicians, covers the maintenance requirements for
common items used at district level (anaesthesia equipment, infant incubators, X-ray equipment,
suction pumps, autoclaves and laundry equipment) including some advice on safety testing and test
instruments. It also includes information on workshops, stock control of parts, and an equipment
inventory code numbering system.
Available from: GTZ
The effective management of medical equipment in developing countries: A series of five papers
Remmelzwaal B (1997). FAKT, Project Number 390
Health Trends and a Vision for the Future

This material covers issues in Section 1.2 on trends in planning and expenditure for health and
healthcare technology, Section 2.2 on issues affecting service delivery in the future, and Section 4.2
on developing a vision of service delivery. The material also covers areas that may be new to some
health service providers, such as healthcare technology assessment, telemedicine, and energy
management. (For more information, refer to the section below on equipment needs). It is listed
alphabetically by title.
Addressing the future of healthcare technology management
Halbwachs H (2001). GTZ, Eschborn, Germany
This paper reminds healthcare technology management practitioners how HTM evolved, and warns
that it will not be successful unless it is integrated into the way health services are managed and
delivered on a daily basis. It lists the requirements for measuring and improving performance, and
undertaking a quality management approach. It suggests actions for all the different players involved
(countries, international organizations, donors).
Available from: GTZ
230
Better health in Africa: Experience and lessons learned

World Bank (1994). Development in Practice Series, World Bank, Washington, USA,
ISBN: 0 8213 2817 4
This book is aimed at policy-makers and sets forth a vision of health improvement that challenges
African countries and their external partners to rethink current health strategies. The report stresses
positive experiences in Sub-Saharan Africa and concludes that far greater progress in improving health is
possible than has been achieved in the past – even within existing resource constraints. It proposes that
a basic set of health services can be provided in low-income Africa at an annual cost of around US$ 13 per
person, presents the key reforms for achieving this, and illustrates the costs and benefits involved.
Available from: World Bank, major internet bookshops
Cost-effective aid for developing economies
This paper explains that as funds for aid are dwindling, there needs to be a more effective utilization
of resources. It presents strategies and criteria which would help aid used to supply equipment to be
more cost effective.
Available from: GTZ
Developing health technology assessment in Latin America and the Caribbean
PAHO (1998). PAHO. ISBN: 92 75 073777
This publication is aimed at policy-makers and health care professionals. The first part provides an
introduction to health technology assessment: why it is important, who does the evaluations, when
and how the evaluations are done. The second part looks at health technology in Latin America and
the Caribbean, and PAHO’s recommendations for promoting health technology assessment.
Available from: PAHO
District health care: Challenges for planning, organization and evaluation in
developing countries (2nd edition)
Amonoo-Larston R, Ebrahim G, Lovel H, and J Rankeen (1996). MacMillan. ISBN: 0 333 57349 8
This book contains practical support and advice intended for those in the planning, management and
evaluation of health services at district level. It covers a wide range of topics based on country
experience, including: district health needs, plans, organization and management; staff motivation,
teamwork, developing management skills, managing change, managing conflicts, and staff
development; managing finances; as well as monitoring and evaluation.
Draft final report of the informal consultation on physical infrastructure, technology and
sustainable health systems
WHO Health Systems Department (1998). WHO, Geneva, Switzerland
This paper looks at the issues surrounding physical infrastructure in health – it does not pretend to
provide the answers but prompts discussion. Using accumulated experience from different countries,
the paper defines the role of physical infrastructure in the development of sustainable health systems,
discusses the opportunities and challenges facing health systems in developing countries due to the
rapid developments in technology, identifies the constraints to progress with effective healthcare
technology management at national and international level, and identifies the current gaps in
knowledge which need to be filled.
Available from: WHO
231
Health and disease in developing countries

Lankinen, K et al (eds) (1994). MacMillan Press. ISBN: 0 333 58900 9
This comprehensive book covers health and disease from the wider perspective of development in
general. It is of particular interest to medical and other professionals working in developing countries
or for international cooperation agencies. It is a valuable resource for district medical officers, and
students taking courses in public health and tropical medicine. Besides sections on: society, economy
and health; infectious diseases; and challenges for health care, there is a section on health services to
meet the challenges. This section contains chapters relating to equipment and/or management such
as health systems management and financing, immunization services, essential laboratory services,
blood transfusion services, and medical equipment management.
Available from: major internet bookshops
Health in the commonwealth: Challenges and solutions 1998/1999
Commonwealth Secretariat (1999). Kensington Publications Ltd, London
This digest of articles covers a wide range of health issues, such as: resources and planning; equity of
access; medical technology and equipment; health promotion; mother and child health; community
health; communicable and non-communicable diseases, etc. The content is aimed at policy-makers
and planners. There is a range of technology articles on equipment management, telemedicine,
radiology, cardiac care, hospital design, sanitation, vector control, water and air supplies.
Available from: Commonwealth Secretariat
Healthcare technology management and health sector reform
This paper presents data and arguments for the need for healthcare technology management to be a
part of health sector reform. It explains how HTM can contribute to health sector reform, and what
needs to be done by the different players involved (countries, international organizations, donors).
Available from: GTZ
Health technology assessment: Methodologies for developing countries
PAHO (1989). PAHO. ISBN: 92 75 12023 4
This publication reviews the main concepts and methodologies involved in assessing the effectiveness,
safety, cost, and social impact of health technologies, and discusses the potential contributions of such
assessments to improving health care delivery in developing countries. It discusses how the
methodologies must be adapted for developing countries, using results from actual examples.
Available from: PAHO
Information technology in the health sector of Latin America and the Caribbean:
Challenges and opportunities for the international technical cooperation
PAHO (2001). Essential Drugs and Technology Program, Division of Health Systems and Services
Development, PAHO. ISBN: 92 75 12381 0.
This publication is aimed at policy-makers and reviews the challenges and opportunities for technical
cooperation in the area of information technology (IT) globally, with a status report from Latin
America and the Caribbean. The diffusion and impact of information technology in healthcare
services and organizations is reviewed. The publication also aims to start the process of defining
measurement indicators for the infrastructure, process, and impact of IT in the health sector.
Available from: PAHO, WHO
ISBN: 0 9627449 6 4
232
Myths and realities about the decentralization of health systems

Kolehmainen-Aitken, R-L. (ed) (1999). Management Sciences for Health, Boston, USA,
ISBN: 0 913723 52 5
This book is aimed at managers and policy-makers, and provides a comprehensive look at the impact
of decentralization on health systems around he world. Decentralization can profoundly influence
both the content and quality of health services and the technical support areas necessary to deliver
the services equitably and efficiently, but there is little information on the challenges of introducing
new policies and services in a decentralized environment. So, this book presents lessons learned to
provide an understanding of the positive and negative consequences of decentralization, and offers
advice on anticipating and dealing with these issues based on experiences in numerous countries.
Available from: Management Sciences for Health
Raab M (1999). Swiss Centre for International Health. August 1999.
Successful energy management of health facilities
Riha J (1994). In Halbwachs H, and R Schmitt (eds) La maintenance dans les systemes de santé/
Maintenance for health systems: 4th GTZ Workshop, Dakar, Senegal, September 1993. GTZ
This paper covers the principles of energy management and its importance for health facilities. It
discusses energy costs, strategies, and obstacles to overcome by the health team.
Available from: GTZ
Technology assessment in healthcare
Raab M (2000). Swiss Centre for International Health
This paper discusses and calls for the need to undertake health care technology assessment in
developing countries, in order to make the best use of new technologies. It presents some strategies
for starting this process.
The world health report 2000: Health systems – Improving performance
WHO (2000). ISBN: 92 4 156198 X
This book is aimed at policy-makers. Drawing from a range of experiences and analytical tools, this
book traces the evolution of health systems, explores their diverse characteristics, and uncovers a
unifying framework of shared goals and functions. The book presents three fundamental goals for
health services, and shows that the achievement of these goals depends on the ability of each health
system to carry out four main functions. It aims to stimulate debate about better ways of measuring
health system performance and thus finding a successful new direction for health systems to follow.
Available from: WHO
World development report 1993: Investing in health
World Bank (1993). Oxford University Press, New York, USA. ISBN: 0 19 520889 7
This report examines the controversial questions surrounding health care and health policy, and
advocates a threefold approach for governments in developing countries and those in transition. First,
to foster an economic environment that will enable households to improve their own health. Second,
to redirect spending away from specialized care and toward low-cost and highly effective activities, by
adopting packages of public health measures and essential clinical care described in the report. Third,
to encourage greater diversity and competition in the provision of health services.
Available from: World Bank
233
Equipment Needs and Equipment Lists

This material covers issues in Section 4.3 on establishing model equipment lists and includes
resources that discuss equipment needs, provide lists of equipment, advise on design and layout
implications relating to the use of equipment, and standardization. It is listed alphabetically by title.
Anaesthesia at the district hospital (2nd edition)
Dobson MB (1988). Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
ISBN: 92 4 154527 5
A practical manual designed to help medical officers in small hospitals acquire competence in the use
of essential techniques for inducing anaesthesia for both elective surgery and emergency care of the
critically ill. Addressed to doctors having at least one year of postgraduate clinical experience, the book
concentrates on a selection of basic techniques, procedures, and equipment capable of producing good
anaesthesia despite the limited resources usually found in small hospitals. The manual was prepared in
collaboration with the World Federation of Societies of Anaesthesiologists.
Available from: WHO
Anaesthetic equipment: Physical principles and maintenance (2nd edition)
Ward C (1985). Baillière Tindall. ISBN: 0 7020 1008 1
This book provides a comprehensive and practical coverage of the wide range of equipment used in
anaesthetic practice. It allows the reader to understand the mode of operation and maintenance of
equipment, and how to cope with common causes of mechanical failure. Suitable for trainee and
established anaesthetists, intensive care specialists, anaesthetic nurses, and theatre and
maintenance technicians.
Available from: book suppliers
A pocket book for safer IV therapy (drugs, giving sets and infusion pumps)
M Pickstone (ed.) (1999). ISBN: 094 867232 3
This pocket book has been written to help clinical staff deliver safe IV therapy. It covers the
calculation of drug dose, the make-up of drug solutions and the selection of infusion devices and
associated equipment.
Approaches to planning and design of health care facilities in developing areas: Vol 3
Kleczkowski B, and R Pibouleau (eds) (1979). WHO Offset Publication No 45. ISBN: 92 4 170045 9
This volume addresses the issue of hospital design in terms of the building structure itself. It
discusses inpatient areas, outpatient department, surgery, radiology department, and mobile facilities.
Equipment issues are specifically covered in the sections discussing layout and flow, alternative ways
of undertaking procedures, the equipping process, and choosing a complete X-ray system for a rural
medical facility.
Available from: WHO
Approaches to planning and design of health care facilities in developing areas: Vol 4
Kleczkowski B, and R Pibouleau (eds) (1983). WHO Offset Publication No 72. ISBN: 924 170072 6
This volume addresses the issue of hospital design in terms of the building structure itself. The
design of a hospital is discussed in the context of geographic and demographic data, utilisation, costs
and available resources. It is a useful resource for planners, architects and administrators. This volume
covers small health care facilities, laboratory facilities, transport systems, local construction materials,
health service management, training, commissioning, and engineering and maintenance services.
Equipment issues are specifically covered in the sections discussing layout and flow, laboratory design,
commissioning, and engineering and maintenance services.
Available from: WHO
234
Design for medical buildings (4th edition)

Mein P, and T Jorgnesen (1988). University of Nairobi, Housing Research and Development Unit;
African Medical and Research Foundation
Construction guidelines for medical buildings with special reference to appropriate designs for
developing and tropical countries. Relationship diagrams, flow of patients, linkages between different
units and services.
Available from: WHO, AMREF
District health facilities: Guidelines for development and operation
WHO Regional Publications: Western Pacific Series No 22 (1998). ISBN: 92 9061 121 9
This revised and expanded book presents detailed, richly illustrated guidelines for the planning and
design of district hospitals including the efficient utilization of space and easy movement of people,
equipment, and supplies. It also provides extensive information on the selection and maintenance of
medical and laboratory equipment, including specifications for a basic radiological system and a
general–purpose ultrasound scanner. Additional material covers sanitation and waste management,
emergencies and disasters, the procurement of essential drugs, and test instruments.
Available from: WHO
Essential equipment for district health facilities in developing countries
Halbwachs H, and A Issakov (eds.) (1994). GTZ, Eschborn, Germany
This book describes the types of equipment required at different levels within the district health
services – at health post level (sub-health centre without beds), at health centre or small district
hospital level (with 1-75 beds), and at district or provincial hospital level (with 76-250 beds). It also
provides guidance on the maintenance skill levels required for each equipment type.
Available from: GTZ, WHO
Essential healthcare technology package (EHTP)
WHO Collaborating Centre for Essential Health Technologies, Medical Research Council, South Africa
The WHO and MRC-SA have developed a tool (concept, methodology, and software) which
systematically relates planning to essential health interventions, rather than relying on static
equipment lists. The software links all internationally classified diseases (ICD codes) to their
respective procedures (CPT codes), then to the technologies (medical devices, drugs, human
resources, facilities) required for their execution. The EHTP templates are modified through country
specific consultations and consensus. An in-built query and simulation capability ensures that
planners can see the implications and costs of their choices. The EHTP is being field tested and
modified in 20 – 25 countries. Various papers are available describing the software and the results of
pilot application studies, contact: heimannp@who.int, or issakova@who.int.
Available from: http://www.ehtp.info
Examples of model equipment lists
A number of health service providers have already developed their own model equipment lists. For
example, more information can be obtained from:
◆ Dr P Asman, Biomedical Engineering Unit, Ministry of Health (Room 33, MOH Building), PO
Box M-44, Accra, Ghana. Email: nchtm@africaonline.com.gh
◆ Ministry of Health, PO Box 7272, Kampala, Uganda. Email: info@health.go.ug, website:
www.health.go.ug/support_system.htm
◆ Ministry of Public Health, Conakry, Guinea. In French. Contact: mboule.andre@hotmail.com
◆ Ministry of Health, Gaborone, Botswana. For district hospitals and primary hospitals. Contact:
Ziken International on info@ziken.co.uk
235
Furniture and equipment in relation to activities, personnel and architecture – Primary and
secondary health care in developing countries
Knebel P (1984). Club du Sahel, OECD
This book, based on experience in the Sahel region, contains lists of the minimum requirements for
furniture and equipment for health facilities. There are also sections on UNICEF ordering
procedures, inventory control, catchment areas, basic demographic assumptions and calculation of
manpower needs. Two additional sections cover, in more detail, i) advice on staffing levels by facility
and activity and, ii) proposed architectural layouts for facilities.
Available from: OECD, WHO
Future use of new imaging technologies in developing countries.
Report of WHO Scientific Group (1985). WHO Technical Report Series No.723. WHO,
Geneva, Switzerland
This document discusses the use of ultrasound and computed tomography and the specifications for
the required equipment.
Available from: WHO
General surgery at the district hospital
Cook J, Sabkaran B, and A Wasunna (eds) (1998). Dept. of Surgery, Eastern General Hospital,
Edinburgh, Scotland. ISBN: 92 4 154235 7
A richly illustrated guide to general surgical procedures suitable for use in small hospitals that are
subject to constraints on personnel, equipment, and drugs. The book presents an overview of basic
principles, and detailed information on simple but standard surgical techniques for the face and neck,
chest, abdomen, gastrointestinal tract, urogenital system, and paediatric surgery. Lists of essential
surgical instruments, equipment and supplies are included.
Available from: WHO
If not in use – switch off!: Guidelines and key recommendations for a sustainable and
cost-effective energy supply for health facilities in remote locations
Röttjes M (1995) FAKT, Stuttgart, Germany
This practical document aims to provide a variety of courses of action that medical and administrative
staff can pursue when health facilities are hit by energy problems. It covers sustainable and cost-
effective energy supplies, the different energy requirements, possible energy sources, and suggestions
for a hospital energy supply. It includes PPM schedules for air-cooled diesel power plants.
Infusion systems
Medicines and Healthcare Regulatory Authority (1995). MDA Device Bulletin, No. DB 9503 (May 1995)
This publication addresses many aspects of the use and selection of infusion systems. Its purpose is to
raise awareness of the nature of infusion systems, their advantages and their potential risks, with a
view to reducing the number of adverse incidents that arise from their use. It describes the different
types of infusion devices, risks and applications, training programmes, safety recommendations,
purchasing, and management responsibilities.
Available from: MHRA
Instrumentation for the operating room: A photographic manual (5th edition)
Brooks Tighe S (1999). ISBN 0323003508
Colour photographic reference manual illustrating in detail a range of instruments for major surgical
procedures: endoscopic, neurosurgery, ophthalmic, orthopaedic, and oral, maxilla and facial surgery.
Also includes a section describing the care and handling of instruments from cleaning to sterilization,
inspection and testing.
236
International Centre for Eye Health (ICEH) standard lists of equipment

ICEH produces annual standard lists of equipment, instruments and optical supplies for eye care in
developing countries.
Available from: online at http://www.ucl.ac.uk/ioo
Medical administration for frontline doctors: A practical guide to the management of
district-level hospitals in the public service or in the private sector (2nd edition)
Pearson C (1990). FSG Communications Ltd, Cambridge, UK. ISBN: 1 871188 03 2
This book provides information for doctors who combine wide clinical responsibilities with
administration and support for primary health care services. It covers a wide range of topics, with
country examples, including: management structures; infrastructure and maintenance; buildings,
support services, and equipment; hospital supplies; training; outreach programmes; and wider
responsibilities in the district and above.
Medicines and Healthcare Regulatory Agency (MHRA, UK) products
This agency of the UK government (formerly the Medical Device Agency) ensures medical devices
and equipment meet appropriate standards of safety, quality, performance, and effectiveness, are used
safely, and that they comply with relevant Directives of the European Union. The MHRA provides a
variety of publications, such as:
◆ Device evaluations (replacing former evaluation reports) which evaluate and compare different
makes and models of equipment
◆ Device bulletins (one of many types of safety warnings produced about specific types, makes and
models of equipment)
◆ Medical device alerts (replacing former hazard notices, safety notices, device alerts, advice
notices, etc.)
◆ Advice on a wide variety of safety topics (visit the website, click on contacts, then medical
devices, then search under a subject area such as decontamination, or laundry for example).
Available from: MHRA
HEART Consultancy
Provisional reference lists of equipment and supplies for peripheral health services
Torfs ME (1975). WHO, Geneva, Switzerland, WHO/SHS/75.2
The document begins with a discussion of the methodology used in drawing up the lists.
Recommended lists of furniture, equipment, supplies, disposables, and pharmaceuticals are provided
for: i) static facilities, ii) mobile facilities, and iii) kits and sets.
Available from: WHO
Selection of basic laboratory equipment for laboratories with limited resources
Johns ML and ME El-Nageh (2000). ISBN: 9290212454
This book provides a framework to help laboratory workers, supply officers and decision makers to
choose and buy laboratory equipment and consumables. Includes information on maintenance and
energy requirements for laboratory equipment, quick reference buyer’s guides and equipment data
specification sheets provide easy reference for equipment buyers. The framework can be adapted to
guide general equipment purchasing.
Available from: WHO
237
Surgery at the district hospital: Obstetrics, gynaecology, orthopaedics and traumatology

Cook J, Sabkaran B, and A Wasunna (eds) (1991). Dept. of Surgery, Eastern General Hospital,
Edinburgh, Scotland. ISBN: 92 4 154413 9
An illustrated guide to essential surgical procedures in small hospitals for treating the major
complications of pregnancy and childbirth, common gynaecological procedures, and managing
traumatic injuries, including fractures and burns. Emphasis is placed on standard surgical protocols
that represent the safest line of action in hospital settings where equipment may be primitive, drugs
limited, and specialist services sparse – these requirements are discussed.
Available from: WHO
Surgical instruments: A pocket guide (2nd edition)
Papanier Wells M, and M Bradley (1998). ISBN: 00721678017
A pocket guide listing and describing surgical instruments: sharps/dissectors, forceps, clamps,
retractors, suction tips, dilators, endoscopic instruments, internal stapling devices, and most
commonly used instrument sets for a variety of surgical procedures. Includes a picture of the
instrument with a brief description explaining the uses, varieties, and alternative names.
See Guide 4 for more literature that discusses equipment needs for particular disciplines but does not
contain lists of equipment, and for training videos.
Equipment Specifications and Appropriate Models

This material covers issues in Section 4.5 on developing generic equipment specifications and
technical data, as well as material that discusses appropriate design of equipment. It is listed
Appropriate medical technology for developing countries: Report of IEE 1st seminar in
February 2000
IEE Medical Focus Group. Report 00/014
This document contains papers on appropriate products that have been designed for use in
developing countries, such as an anaesthetic machine, diagnostic instruments for primary health care,
laboratory equipment, and an incinerator. It also contains discussions on issues such as solar power,
repair and maintenance of equipment, selection and procurement options, and sustainability.
Available from: IEE
Appropriate medical technology for developing countries: Report of IEE 2nd seminar in
February 2002
IEE Healthcare Technologies Professional Network. Report 02/057
This document contains papers on appropriate products that have been designed for use in
developing countries, such as a healthcare technology management information system, laboratory
equipment, a growth monitor, observation of respiratory dysfunction, a virtual doctor system, solar
energy, ophthalmic examination and surgical equipment. It also contains discussions on issues such as
a global medical devices nomenclature, management systems, the use of Cobalt 60 teletherapy for
cancer, a call for a biomedical instrument development centre, and an update of the anaesthetic
machine, diagnostic tools for medical surveillance, and an incinerator
Available from: IEE
Appropriate medical technology for developing countries: Report of IEE 3rd seminar in
February 2004
IEE Healthcare Technologies Professional Network. UK ISSN: 0963 3308, reference no.: 03/10408
This document contains mainly scientific papers on research and design work being undertaken on
appropriate products and techniques for developing countries.
Available from: IEE
238
District health facilities: Guidelines for development and operation

WHO Regional Publications: Western Pacific Series No 22 (1998). ISBN: 92 9061 121 9
Emergency Care Research Institute (ECRI, USA) products
ECRI
Examples of equipment specifications and technical data
A number of health service providers have developed their own equipment specifications, package of
inputs to purchase, national technical data, and supply contracts. For example, more information can
be obtained from:
◆ Dr P Asman, Biomedical Engineering Unit, Ministry of Health (Room 33, MOH Building),
PO Box M-44, Accra, Ghana. Email: nchtm@africaonline.com.gh
◆ Ministry of Health, PO Box 7272, Kampala, Uganda. Email: info@health.go.ug,
website: www.health.go.ug/support_system.htm
◆ Ziken International, contact: info@ziken.co.uk
Future use of new imaging technologies in developing countries.

Report of WHO Scientific Group (1985). WHO Technical Report Series No.723. WHO, Geneva,
Switzerland
HEART Consultancy
UNICEF supply catalogue (formerly the UNIPAC catalogue)
UNICEF
This catalogue lists products with their specifications under categories such as: immunization and
cold chain; medical devices and kits; water, environment, sanitation and engineering; education,
communication; etc. View it online at www.supply.unicef.dk/Catalogue.
Available from: UNICEF Denmark
Cost and Budgeting Information

This material covers issues in Sections 5 and 6 such as resources that discuss the various costs
incurred when owning equipment and how to calculate them, how to make budget estimates, how to
make savings, how to undertake cost-benefit analysis. It is listed alphabetically by title.
A study into the costs of running X-ray equipment in a SCIH project in Egypt
Raab M, and G Hutton (2001). Swiss Centre for International Health, Basle, Switzerland
This paper investigates the cost and financing for a project in Egypt to provide X-ray machines. It
shows how the costs incurred during the life cycle of the equipment can be calculated, estimated and
summarized. The evaluation study classified costs as investment costs (money required at the start of
the project), recurrent costs (money required to make the project sustainable), and incremental costs
(additional costs to those covered by the Ministry of Health). The information on investment and
recurrent costs gave the decision makers a picture of (potential) impact on budgets, and how much
budgets should be adjusted to accommodate the project.
239
Better health in Africa: Experience and lessons learned

World Bank (1994). Development in Practice Series, World Bank, Washington, USA,
ISBN: 0 8213 2817 4
Cost-benefit calculation models for optimizing technology management in
healthcare facilities
Raab M (1999). Swiss Centre for International Health
This paper presents a set of tools for evaluating the costs related to clinical engineering services
(whether in-house, externally contracted, or a mixture of both). These costs are balanced against the
benefits reaped by the health service provider. The method of analysis used has been tested in a
number of countries (mainly those in transition).
Engineering and maintenance services in developing countries
Mehta, J.C. (1983) in Approaches to planning and design of health care facilities in developing
areas: Vol 4, B.M. Kleczkowski, R. Pibouleau. (eds), WHO Offset publication No 72
This document is based on over 8 years of experience of the maintenance system in a government
hospital in India. The document discusses maintenance for the hospital as a whole including
buildings, plant, and equipment. There are sections on maintenance management, activities of the
hospital engineering and maintenance department, planning the maintenance program, personnel,
services to offer, and tables of estimated costs of maintenance for different types of equipment as a
percentage of capital cost.
Available from: WHO
Estimated useful lives of depreciable hospital assets (revised 2004 edition)
American Society for Hospital Engineering (2004). American Hospital Association.
ISBN: 1 55648 319 8
One of the organizations which have tried to estimate typical equipment lifetimes for healthcare
technology. The AHA’s extensive list reflects how equipment lasts within the United States’ health
care system whether it was manufactured in the US or abroad. It covers buildings, estate, fixed
equipment, and individual items of movable equipment. The list was compiled after discussions with
manufacturers of healthcare equipment, discussions with various hospital department managers, and
analysis of actual retirement practices for actual hospital assets.
Available from: AHA
Healthcare equipment management
Halbwachs H. (1994). pp 14-20 in Health Estate Journal, December 1994, Portsmouth UK
Health economics for developing countries: A practical guide
Witter S et al (2000). Macmillan, UK, ISBN: 0 333 75205 8
This book is an introduction to health economics and finance for low-income countries, which is easy to
read and does not assume previous training in economics. It explains health economics in an accessible
lively way using material from, and relevant to, developing countries. The focus is on practical use
with worked examples and practice exercises. There are sections covering many topics, including
health and development, financing health care, the value of cost information for allocating resources,
organizational issues such as decentralization, public/private provision, and improving efficiency.
240
Maintenance and the life expectancy of healthcare equipment in developing economies

Hans Halbwachs, GTZ. In Health Estate Journal (March 2000) pp 26-31
This article comes from one of the organizations that have tried to estimate typical equipment
lifetimes for healthcare technology. The GTZ estimates are for 16 types of medical equipment and
plant, and tries to more closely reflect the realities in developing countries. The article describes the
Delphi survey used to obtain feedback from 23 experts from 16 different country backgrounds. Rather
than providing exact lifetimes, this approach provides a range for the lifetime that depends on the
quality of the initial equipment and how well it has been maintained.
Available from: GTZ
Medical equipment in developing countries: Two neglected issues – planning and financing
Berg H (1992). WHO Document WHO/SHS/CC/92.2
This document is aimed primarily at health planners. It describes planning problems, and outlines the
procedures that should occur before equipment is purchased in order to ensure that the implications
of ownership are known. It looks at the recurrent cost implications of equipment, and presents a
method for unit costing and shows the consequences through examples.
Available from: WHO
ISBN: 0 9627449 6 4
Physical assets management and maintenance in district health management
Halbwachs H (2000). GTZ document
Reflections on the economy of maintenance: Presentation at the summit conference of the
African Federation for Technology in Healthcare, Harare, Zimbabwe, 1998
Riha J, Mangenot L, Halbwachs H, and G Attemené. (1998). GTZ
This paper aims to provide convenient quantitative guidelines for engineers, administrators and
decision makers on the cost implications of maintenance approaches. It explores how to define an
annual maintenance cost ceiling by relating maintenance cost to the expected increase in equipment
lifetime. This is achieved though the use of various equations with worked examples.
Available from: GTZ
The right equipment... in working order
Bloom GH et al (1989). Reprinted from World Health Forum, Vol 10, No. 1, pp 3 – 27. WHO,
Geneva, Switzerland
This document contains a series of papers that discuss planning and budgeting issues for healthcare
technology in developing countries. They contain cost estimates (as a percentage of the capital stock
value), financial planning implications, constraints and strategies.
Available from: WHO
The technical and financial impact of systematic maintenance and repair services within
health systems of developing economies or ‘How good is my maintenance service?’
Halbwachs H (1998).pp57-60 in Proceedings of the IFHE 15th International Congress, Edinburgh,
June 1998, International Federation of Hospital Engineering
This paper describes, with country examples, the consequences of a lack of maintenance and repair,
and how the introduction of planned preventive maintenance and repair services can benefit the
health service by providing a positive economic impact. It covers how to measure the quality of
maintenance services using process, impact, and cost indicators, including savings calculations. It
reports on the results of studies in three countries on the cost-effectiveness of maintenance services.
It also describes a suitable national body through which donors could provide financial contributions
to maintenance services.
Available from: GTZ, IFHE
World development report 1993: Investing in health
World Bank (1993). Oxford University Press, New York, USA. ISBN: 0 19 520889 7
241
See Guide 6 for more information and resources covering financial management, running Healthcare
Technology Management Services as businesses that can generate profits, and preparing budgets for
HTM Services.
Developing Skills and an Equipment Training Plan, and Managing Change

This material covers issues in Section 2.1 on managing change, and Section 7.2 on developing an
equipment training plan. It is listed alphabetically by title.
A book for midwives
Klein, S (1996). Hesperian Foundation. ISBN: 0 942364 23 6
This book provides practical information on antenatal care, labour, birth and post-partum care. It also
includes a section on making teaching materials and low-cost equipment.
District health care: Challenges for planning, organization and evaluation in developing
countries (2nd edition)
Healthcare technology: Training skills for hospital technicians and engineers
FAKT (1999). FAKT Technical Library Data Sheet
This paper discusses the major objectives of training both on- and off-the-job. It then provides
practical guidance on how to undertake on-the-job training effectively by using the PESOS
procedures (prepare, explain, show, observe, supervise). It explains each step in detail. Although
written for maintenance staff, its advice is just as useful for any other types of staff.
Hospital engineering in developing countries
Dammann V, and H Pfeiff (eds) (1986). GTZ, Eschborn, Germany. ISBN: 3 88085 293 6
Hospital technology: Communication – a vital skill for successful healthcare technical
service management
FAKT (1999). FAKT Technical Library Data Sheet
This paper discusses the importance of communication for both working in a team and working in an
organization/network. It provides advice on how to communicate effectively, its importance, the
barriers that exist, how to promote effective communication, the role of the head of department,
methods to use, and related reading. Although written for maintenance staff, its advice is just as
useful for any other types of staff.
How to make and use visual aids
Harford, N and N Baird (1997). VSO. ISBN: 043592317X
This booklet describes a number of useful and practical methods for making visual aids quickly and
easily, using low cost materials.
Available from: TALC, VSO
Maintenance strategies for public health facilities in developing countries: Report of a
workshop held in March 1989 in Nairobi by GTZ
Halbwachs H, and R Korte (1990). WHO/SHS/NHP/90.2
This report presents the results of a workshop attended by 60 participants from 18 countries including
project staff and counterparts from GTZ projects in various countries, representatives of various donor
agencies, and resource persons. The papers included address the different types of personnel required
in maintenance services, the training they require, experiences of establishing national training courses
in hospital maintenance, and ways to monitor progress with maintenance and training.
Available from: GTZ, WHO
242
Management support for primary health care: A practical guide to management for health
centres and local projects
Johnstone, P, and J Ranken, (1994). FSG Communications Ltd, Cambridge, UK. ISBN: 1 87118 02 4
This practical user-friendly book gives support and guidance to leaders in health centres and other
local projects to help stimulate and maintain primary health care (PHC) in their surrounding
communities. Aid workers, and others unfamiliar with PHC and basic management techniques may
also benefit. Includes sections which will assist with staff motivation, such as teamwork and team
effectiveness; managing oneself, others and tasks; and managing change, as well as sections on
planning and monitoring progress.
Medical administration for frontline doctors: A practical guide to the management of
district-level hospitals in the public service or in the private sector (2nd edition)
Pearson C (1990). FSG Communications Ltd, Cambridge, UK. ISBN: 1 871188 03 2
Medical equipment in Botswana: A framework for management development
Temple-Bird C L, Mhiti R, and G H Bloom (1995), WHO publication WHO/SHS/NHP/95.1
On being in charge: A guide to management in primary health care (2nd edition)
McMahon R, Barton E, and M Piot (1992). ISBN: 9241544260
This practical guide aims to improve the managerial skills of middle level health workers. The text is
reinforced with practical examples, questionnaires and illustrations that help relate the information to
health workers’ own experiences. Topics include identifying health problems, assigning priorities to
their solution, planning and implementing programmes, and evaluating results. Also serves both as a
training and reference guide, covering all aspects of primary health care management including
equipment and drugs.
Available from: WHO
Setting up community health programmes: A practical manual for use in developing
Lankester, T. (2000). ISBN: 0333679334
A practical ‘how-to’ manual designed for a wide range of health workers working with community
health programmes. With revised and updated material on planning, management and evaluation of
health programmes ranging from choosing and training a team through the setting up of clinics and
advising village health workers. Includes new information on community-based approaches to safe
motherhood, immunisation, malaria and TB based on WHO guidelines.
Training health personnel to operate health-care equipment: How to plan, prepare and
conduct user training – A guide for planners and implementors
Halbwachs H, and R Werlein, (1993). GTZ, Eschborn
The aim of this book is to ensure that users are in a position to operate equipment and plant without
causing failure or malfunction. Part one addresses the planner/administrator developing user courses
and gives information about methods, course organization, finances, etc. Part two discusses
interesting issues for the implementers i.e. how to design a course, teaching methods and teaching
aids, conducting a course, etc. This practical guide provides sample checklists, questionnaires,
worksheets, tests, certificates, etc.
Available from: GTZ
Transfer of learning: A guide for strengthening the performance of health care workers
Intrah/PRIME II/JHPIEGO (March 2002)
This book is for health care workers involved in training and learning interventions and enables them
to transfer their newly acquired knowledge and skills to their jobs, resulting in a higher level of
performance and sustained improvement in the quality of services at their facilities.
Available from: free online at http://www.prime2.org/prime2/section/70.html
243
WHO Interregional meeting on manpower development and training for health care
equipment management, maintenance and repair: Campinas, Brazil, November 1989
WHO (1989). WHO document WHO/SHS/NHP/90.4
This document provides a comprehensive discussion of the complexities of manpower development
and training for healthcare technology maintenance and management, as well as proposed strategies.
It uses reports from countries, participating institutions and organizations regarding skill
development for healthcare technical services. It discusses the needs, professional development, use
of an equipment survey to determine manpower requirements, certification, and job descriptions.
Available from: WHO
See all other Guides in the Series for information on the training requirements specific to the topics
covered by each Guide.
Equipment Development Plans, Budgets, and Monitoring Progress

This material covers issues in Sections 7 and 8 on equipment development plans, income and
expenditure plans (budgets), and Section 8 on target-setting and monitoring progress. It is listed
District health care: Challenges for planning, organization and evaluation in developing
Maintenance strategies for public health facilities in developing countries: Report of a
workshop held in March 1989 in Nairobi by GTZ
Halbwachs H, and R Korte (1990). WHO/SHS/NHP/90.2
Management support for primary health care: A practical guide to management for health
centres and local projects
Johnstone, P, and J Ranken, (1994). FSG Communications Ltd, Cambridge, UK. ISBN: 1 87118 02 4
ISBN: 0 9627449 6 4
On being in charge: A guide to management in primary health care (2nd edition)
McMahon R, Barton E, and M Piot (1992). ISBN: 9241544260
Planning and budgeting software
Preparation of equipment development plans, expenditure plans, and budgets is an area where simple
computer software programs can be of assistance once you have mastered a manual paper system, have
a large enough stock (several hundred items of major equipment), and can obtain sufficient training of
staff. The software should be a spreadsheet application, in which you can enter formulae to
manipulate the data in each column. There are a variety of products available with different
advantages, for example:
◆ OpenOffice software is free to download and use. It includes typical desktop applications: word
processor, spreadsheet, presentation manager, and drawing program. It works with a variety of file
formats and platforms, and various languages. It is run by a community of developers and end-
users. Website: www.openoffice.org, and look for the latest stable release to download.
◆ Any commercially available spreadsheet software can be purchased. Excel (the spreadsheet
application part of Microsoft Office) is readily available from any computer distributor, is
commonly available on health service provider’s computer systems, but is a more expensive option.
Website: www.microsoft.com/office/excel for information, viewing, and download possibilities.
Although many other products are available.
◆ Tailor-made budgeting software products have many features, however they are often more
complex and expensive than required, and than a straightforward spreadsheet. These products can
be found by searching for budgeting software on the internet.
244
◆ The ‘Health Manager’s Toolkit’ is a product produced by Management Sciences for Health that
includes spreadsheet templates, forms for gathering and analyzing data, checklists, guidelines for
improving organizational performance, and self-assessment tools that allow managers to evaluate
their organizations. Tools cover areas such as strategic planning, developing information systems,
cost and revenue analysis, and sustainability. Website: http://erc.msh.org/toolkit.
Setting up community health programmes: A practical manual for use in developing
Lankester, T. (2000). ISBN: 0333679334
Raab M (1999). Swiss Centre for International Health. August 1999
The division for the supply of medical spare parts in the health system of Kenya
Paton J, Green B, and J Nyamu (1996). Ministry of Health, Nairobi/GTZ, Eschborn, Germany
This paper describes how a Division for the Supply of Medical Spare Parts was set up and is run in the
health system of Kenya, financed through the use of a revolving fund.
Available from: GTZ
The technical and financial impact of systematic maintenance and repair services within
health systems of developing economies or ‘How good is my maintenance service?’
Halbwachs H (1998). pp 57-60 in Proceedings of the IFHE 15th International Congress,
Edinburgh, June 1998, International Federation of Hospital Engineering
Accessing Information
These websites are sources of information concerning many aspects of health service delivery. They
are locations where there is, or may be, information about healthcare technology management and the
planning and budgeting requirements for equipment.
Africa online: Health website: http://bamako.africaonline.com/afol/index.php
Provides links to health information sites related to Africa. The links are organized into the following
categories: health information, health news, events, African organizations, international organizations,
schools and hospitals in Africa, projects, publications and health services
AFRO-NETS (African networks for health research and development)
website: www.afronets.org
Forum for exchanging health research information in and between East and Southern Africa.
AJOL (African journals online) website: www.inasp.org.uk/ajol
Offers free online access to tables of contents and abstracts of over 70 journals published in Africa.
British medical journal website: http://bmj.bmjjournals.com/
Free worldwide access to BMJ and the student BMJ and a wide range of specialist journals to users in
low-income countries.
Eurasia health knowledge network (EHKN) website: www.eurasiahealth.org
Specialises in the health information needs of the Former Soviet Union (FSU) and Central and
Eastern Europe (CEE). Site links to clinical practical guidelines, medical textbooks, and other
educational materials, many in Russian and other regional languages
FIN: Free international newsletters: www.healthlink.org.uk
Healthlink produces this publication that lists over 130 print and electronic health-related
newsletters and magazines which are available free to readers in developing countries.
Free medical journals website: www.freemedicaljournals.com
This site is a comprehensive, up to date list of medical journals available free on the internet.
GATE (German Appropriate Technology Exchange): www5.gtz.de/gate/
The GATE Information Service seeks to improve the technological knowledge of organizations and
individuals involved in poverty alleviation projects and to develop information and knowledge
management systems of organizations.
245
Global Medical Devices Nomenclature (GMDN) website: www.gmdn.org/index.xalter

The GMDN is a collection of internationally recognized terms used to accurately describe and
catalogue medical devices. It is a classification system developed to allow for the classification of all
medical devices put onto the market as defined by the European Standards body (CEN). It is intended
to replace the older national device nomenclatures such as UMDNS (USA), CNMD (Canada), NKKN
(Norway), JFMDA (Japan), in order to promote consistency in terminology around the world. The
system has been accepted by the International Organization for Standardization (ISO).
Health exchange website: www.healthcomms.org
Explores issues, ideas and practical approaches to health improvement in developing countries and
provides a forum for health workers and others to share viewpoints and experiences in this area.
HealthNet news website: www.healthnet.org/medpub
Weekly newsletter distributed to health professionals in Africa, Asia and Latin America. Features
current, practical, clinical and public health information.
HIF-net at WHO discussion group
Discussion list dedicated to issues of improving access to reliable health information in resource-poor
settings. To join, email your name, affiliation and professional interests to: health@inasp.info
HINARI (Health inter-network access to research initiative) website:
www.healthinternetwork.net
WHO initiative offering free/discounted access to journals from six leading publishers.
HNP flash website: www.worldbank.org/hnpflash
A free monthly electronic newsletter dedicated to sharing knowledge regarding the latest technical
developments in the fields of health, nutrition, population, and reproductive health.
ID21 health website: www.id21.org/health
An internet based development research reporting service for health policy makers and development
practitioners on global health issues. Latest research summaries are provided on a searchable website,
by email and in a quarterly publication.
IEC website: www.iec.ch
International Electrotechnical Committee, which sets standards for the safe manufacture of electrical
healthcare technology. There is a wide range of specific standards for medical electrical equipment
falling under the standard numbers IEC 60101–1,2, and 3.
IEE healthcare technologies professional network website: www.iee.org/pn/healthtech
The Institution of Electrical Engineers of the UK provides internet sites for a wide variety of
engineering professions, with the aim of enabling people to communicate with their peers around the
world and access the latest global industry news and key information sources. One of their professional
networks focuses on healthcare technologies. It has also hosted a series of seminars on Appropriate
medical technology for developing countries, and their reports can be obtained from the IEE.
INFRATECH discussion group
WHO forum for global exchange of information on infrastructure and health care technology issues
To subscribe send an email to LISTSERV@LISTSERV.PAHO.ORG enter in text: subscribe infratech
‘your full name’.
International health exchange website: www.ihe.org.uk
Provides training, information and advice to health workers in emergency aid and development
situations. This site also provides information about jobs and health development issues.
246
International journal of technology assessment in health care website:

www.cambridge.org/uk/journals/journal_catalogue.asp?historylinks=ALPHA&mnemonic=THC
This journal serves as a forum for professionals interested in the assessment of medical technology, its
consequences for patients, and its impact on society. It covers the generation, evaluation, diffusion,
and use of health care technology through essays, research notes, regular columns on technology
assessment reports, and sections devoted to particular topics. Sometimes there are articles with
particular relevance to developing countries. In 1994, the Cambridge University Press produced a
book of reprints called Technology assessment in health care for developing countries.
Email: journals-subscription@cambridge.org.
KAR (Knowledge and research programme on disability and healthcare technology) website:
www.kar-dht.org, and for the latest projects being funded use website: www.disabilitykar.net/
This is the Knowledge and Research Programme on disability and healthcare technology of the UK
governments’s Department for International Development (DFID). It supports a range of projects on
development and use of appropriate disability and healthcare technologies in developing countries.
The website also provides links to:
◆ Disability and healthcare technology newsletter produced every six months describing the
progress and findings of the projects funded;
◆ KaR global database on healthcare technology publications, organizations, manufacturers,
training institutions, etc.
NICE (National Institute of Clinical Excellence) website: www.nice.org.uk
Provides guidance to the UK National Health Service (NHS) on current best practice covering both
health technologies (from medicines to diagnostic techniques) and the clinical management of
specific conditions.
Programme for appropriate technology in health (PATH) website: www.path.org
PATH identifies, develops and applies appropriate technologies to public health problems in
developing countries.
Public health care laboratory website: www.phclab.com
Global forum of information exchange and resource centre for laboratory personnel and those
concerned with PHC laboratory services in developing countries.
TechNet (Technical network for strengthening immunisation services) website:
www.technet21.org
Forum focusing on improving management and operational logistics for health service delivery in
developing countries, in particular, immunisation services.
The manager’s electronic resource center website: http://erc.msh.org
The ERC website is an electronic information resource and communication service for health
managers, containing more than 150 ready-to-use management tools in various languages. A key
feature is The health manager’s toolkit – see the discussion on planning and budgeting software in
the section above.
WHO: Health technology and pharmaceuticals website: www. who.int/technology
This WHO site provides information on pharmaceutical and health technology developments with a
particular focus on developing countries. It includes links to blood transfusion safety and clinical
technology, essential drugs, medicines, vaccines and biologicals.
WHO: Management of health services (MAKER) website: www. who.int/management
This WHO site provides information, publications, and country experiences on all types of
management issues for health services, such as facility management, resource management, and
district management.
World Bank website: www.worldbank.org
This site should provide access to World Bank guidelines for equipping health facilities.
247
ii. Organizations, Sources of Publications in Part i, Resource and

Information Centres
For the following institutions we have included the name, address, contact details, a brief description
of the various services they offer, and additional contact details for further relevant activities.
AfriAfya
AMREF Building, PO Box 30125, Nairobi, Kenya
Tel: 254 2 609520, fax: 254 2 609518, email: info@afriafya.org, website: www.afriafya.org
Established by Kenya-based health agencies, AfriAfya provides community access to relevant and
appropriate health knowledge and information in an interactive manner. As well as a section on
HIV/AIDS there is a news centre, message board and discussion forum on their website.
Amazon Bookshop
PO Box 81226, Seattle, Washington 98108-1226, USA
Website: www.amazon.com or www.amazon.co.uk
Internet bookshop
American Hospital Association
Clinical Engineering Section, 840 North Lake Shore Drive, Chicago, Illinois 60611, USA
Website: http://aharc.library.net/
They produce a wide range of documents which are published by HealthForum, use
website:www.ahaonlinestore.com
AMREF International (African Medical and Research Foundation)
Resource Centre, AMREF Headquarters, Langata Road, PO Box 00506 – 27691, Nairobi, Kenya
Tel: 254 2 501301/2/3, fax: 254 2 609518, e-mail: amref.info@amref.org, website: www.amref.org
Publishes practical books, journals and other literature for health workers, and provides advice on
primary health care. Runs training courses and seminars.
BOND (British Overseas NGO’s for Development)
Website: www.bond.org.uk
A network of more than 260 UK based voluntary organisations working in international development and
development education. BOND works to promote the exchange of experience, ideas and information by
acting as a broker for a variety of relationships and by collating and distributing information.
Commonwealth Secretariat
Marlborough House, Pall Mall, London, SW1Y 5HX, UK
Tel: 44 207 747 6500, fax: 44 207 930 0827, website:
www.thecommonwealth.org/publications/html/contactus.asp
This website provides access to the publications produced by the Commonwealth Sectretariat.
De Montfort medical waste incinerators
Website: www.mw-incinerator.info/en/101_welcome.html
This website provides information on De Montfort University incinerators designed by Prof. DJ
Picken. It contains copies of drawings and instructions for the building, operation and maintenance of
various incinerator models. The range of DMU incinerators has been developed for use by rural PHC
facilities, and designed to be constructed on site using local materials. There may be a small charge to
cover the cost of printing and postage of the plans.
DFID (Department for international development)
Website: www.dfid.gov.uk
UK government’s department for international development assistance.
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ECHO International Health Services Ltd

ECHO International Health Services is no longer trading as it used to. Its services can be accessed as
follows:
i. the charitable foundation can be contacted at:
ECHO, Ullswater Crescent, Coulsdon, Surrey, CR5 2HR, UK
Tel: 44 208 6602220, fax: 44 208 6680751, website: www.echohealth.org.uk/intro2.html
ii. the trading branch of the business (wholesale providers of medical supplies and equipment) is now:
Durbin PLC, 180 Northholt Road, South Harrow, Middlesex, HA2 0LT, UK
Tel: 44 208 8696500, fax: 44 208 8696565, email: cataloguesales@durbin.co.uk, website:
www.durbin.co.uk
iii. ECHO publications are still available from TALC (see below).
ECRI (Emergency Care Research Institute)
5200 Butler Pike, Plymouth Meeting, Pennslyvania 19462-1298, USA
Tel: 1 610 825 6000 ext 5368, fax: 1 610 834 1275, website: www.ecri.org
Offers guidance and advice on health care technology, planning, procurement and management; and
health technology assessment and assistance.
Elsevier Health Science
Elsevier Books Customer Services, Linacre House, Jordan Hill, Oxford, OX2 8DP, UK
Tel: 44 1865 474110, fax: 44 1865 474111, email: eurobkinfo@elsevier.com,
website: www.us.elsevierhealth.com
Books published by WB Saunders, Mosby, Churchill Livingstone, and Butterworth-Heinemann are
now all members of the Elsevier Science, Health Sciences Division.
European Union (EU)
http://europa.eu.int/comm/development/index_en.htm
EU site for international development and aid.
FAKT (Consultancy for Management, Training, and Technologies)
Gansheidestrasse 43, D-70184 Stuttgart, Germany
Tel: 49 711 21095/0, fax: 49 711 21095/55, email: fakt@fakt-consult.de, website: www.fakt-consult.de
Non-profit consultancy firm, that provides information on appropriate hospital and medical
equipment and training in healthcare technologies. FAKT is not a supply organisation.
Global Directory of Health Information Resource Centres.
Health Information for Development (HID) Project, PO Box 40, Petersfield, Hants, GU32 2YH, UK
Tel: 44 1730 301297, fax: 44 1730 265398, email: iwsp@payson.tulane.edu,
website: www.iwsp.org/directory.htm
This is a directory of health information resource centres that is arranged alphabetically by country.
Between January 2000 and May 2001, Health Information for Development (HID) compiled a Global
Directory of Health Information Resource Centres (HIRCs). This is available from their website. The
Directory is updated on an ongoing basis.
GTZ (Deutsche Gesellschaft für Technische Zusammenarbeit – German government technical
aid agency)
Division of Health and Education, PO Box 5180, D-6236, Eschborn, Germany
Tel: 49 6196 791265, fax: 49 6196 797104, email: Friedeger.Stierle@gtz.de
Website: http://www.gtz.de/de/4030.htm
Friedeger Stierle is the contact for the GTZ’s healthcare technology management programme, and
any articles or documents on HTM.
Healthlink Worldwide
Cityside, 40 Adler Street, London, E1 1EE, UK
Tel: 44 20 7539 1570, fax: 44 20 7539 1580, email: info@healthlink.org.uk, website:
www.healthlink.org.uk
Publishes a range of free and low-cost newsletters, resource lists, briefing papers and manuals about
health and disability. Publications include HIV testing: a practical approach which is a briefing
paper on HIV counselling and laboratory testing.
249
HEART Consultancy
Quadenoord 2, 6871 NG Renkum, The Netherlands
Tel: 31 317 450468, fax: 31 317 450469, email: jh@heartware.nl, website: http://www.heartware.nl
Consultancy firm working in all aspects of healthcare technology management in developing
countries. It also produces and supplies the PLAMAHS software package for managing the inventory,
model lists, maintenance, and procurement needs for your healthcare technology stock. HEART also
undertakes research and training, and produces publications on many aspects of sterilization for
developing countries. It has developed a basic testkit for performance testing of sterilizers, and can
identify suppliers that still manufacture basic sterilizers (manually operated/fuel heated).
HMSO (Her Majesty’s Stationery Office)
Website: www.hmso.gov.uk
Publishers of material produced by departments of the UK government.
Humanitarian Information for All
c/o Human Info NGO vzw and Humanity CD Ltd, Oosterveldlaan 196, B-2610 Antwerp, Belgium
Fax: 32 3 449 75 74, email: humanity@humaninfo.org, website:
http://media.payson.tulane.edu:8086/cgi-bin/gw?e=t1c11copyrigh-mhl-1-T.1.B.21.1-500-50-
00e&q=&a=p&p=home
The goal of this organization is to disseminate health care information free-of-charge in developing
countries. Thus, their Medical and Health Library makes publications available on the internet. Refer
to their homepage to find the large list of publications available.
Institution of Electrical Engineers (IEE)
Savoy Place, London, WC2R 0BL, UK
Tel: 44 207 240 1871, Fax: 44 207 240 7735, email: postmaster@iee.org, website: www.iee.org.uk
Largest professional engineering society in Europe with worldwide membership for those working in
electronics, electrical, manufacturing and IT professions. Produces a wide range of publications, is a
source of a wide range of information, and has a Healthcare Technologies Professional Network.
Copies of their publications are available from IEE Publication Sales Department, Michael Faraday
House, Six Mills Way, Stevenage, Herts, SG1 2AY, UK
Tel: 44 1438 767 328, fax: 44 1438 742 792, email: sales@iee.org.uk
Intermediate Technology Development Group (ITDG) and ITDG Publishing
The Schumacher Centre for Technology and Development, Bourton Hall, Bourton-on-Dunsmore,
Rugby, CV23 9QZ, UK
Tel: 44 1926 634400, fax: 44 1926 634401, email: enquiries@itdg.org.uk, website: www.itdg.org
The Development Group is a charity concerned with the research and development of ‘appropriate’
technologies for application in developing countries. It has worked on topics such as alternative
electrical supplies, access to water, disability aids, medical supplies. It also undertakes consultancies.
The Publication Division produces and disseminates books and journals covering aspects of health,
development, and appropriate technology. It can be contacted at:
Tel: 44 1926 634501, fax: 44 1926 634502, email: itpubs@itpubs.org.uk,
website: www.itdgpublishing.org.uk.
International Centre for Eye Health (ICEH)
International Resource Centre, Institute of Opthalmology, University College London, 11-43 Bath
Street, London, EC1V 9EL, UK
Tel: 44 20 7608 69 23/10/06, fax: 44 20 7250 3207, email: eyeresource@ucl.ac.uk, website:
www.ucl.ac.uk/ioo
Advises and publishes information on all aspects of eye care including prevention of blindness.
Produces the Community eye health journal distributed free to developing countries, an annual
standard list of medicines, equipment, instruments and optical supplies for eye care for developing
countries, and teaching slides/text sets and videos.
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International Federation of Hospital Engineering (IFHE)

Website: http://home.enter.vg/ifhe/main.html
This body enables national engineering professional organizations to join in a world-wide federation.
It encourages and facilitates exchange of information and experience in the broad field of hospital and
healthcare facility design, construction, engineering, commissioning, maintenance, and estate
management. It arranges an International Congress every two years at different locations, in
conjunction with a healthcare trade exhibition. The reports of the papers presented at these
congresses are sources of information on the changing requirements for many topics, such as
sterilization, air flow control, waste management, equipment safety, etc. It publishes a newsletter.
International Society for Technology Assessment in Health Care (ISTAHC)
c/o Institute of Health Economics, 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada T5J 3N4
Tel: 780 448 4881, fax: 780 448 0018, email: info@HTAi.org, website: http://www.htai.org/
International non-profit body with regional branches, it researches and disseminates information
concerning health technology assessment. It produces the International Journal of Technology
Assessment in Health Care, and has a Special Interest Group on developing countries' issues:
International Society for Technology Assessment in Health Care – Special Interest Group
(ISTAHC-SPIG), Health Technology Research Group, Medical Research Council (MRC), PO Box
19070, Tygerberg 7505, Cape Town, South Africa. Tel: 27 21 938 04 13, fax: 27 21 938 03 85.
Management Sciences for Health (MSH)
Development Office, and/or Publications Office, 165 Allandale Road, Boston MA 02130-3400, USA
Tel: 1 617 524 7799, fax: 1 617 524 2825, email: development@msh.org, website: www.msh.org
MSH undertakes consultancies with health care policy-makers, managers, providers, and clients to
seek to increase the effectiveness, efficiency, and sustainability of health services by improving their
management. MSH also publishes and distributes practical, experience-based books and tools in
multiple languages for health and development professionals, managers and policy makers. Email:
bookstore@msh.org, website: www.msh.org/publications
Medical Research Council South Africa (MRC-SA)
PO Box 19070, 7505 Tygerberg, South Africa
Tel: 27 21 9380911, fax: 27 21 9380200, email:info@mrc.ac.za, website: www.mrc.ac.za
The MRC-SA’s mission is to improve the nation’s health status and quality of life through relevant
and excellent health research aimed at promoting equity and development. They have a WHO
Collaborating Centre for Essential Technologies in Health, at website:
www.mrc.ac.za/innovation/whocollaborating.htm
Medicines and Healthcare Regulatory Agency (MHRA)
Hannibal House, Elephant and Castle, London, SE1 6TQ, UK
Tel: 44 0207 972 8000, email: devices@mhra.gsi.gov.uk, website: www.mhra.gov.uk
Offers guidance, advice, and regulations on medical device quality, safety, performance, use,
and standards.
MSc Envirohealth Products
25 Reedbuck Crescent, Corporate Park, PO Box 506, 15 Randjesfontein, Midrand 683, South Africa
Tel: 27 11 314 7540, fax: 27 11 314 7535, email: scaine@mweb.co.za
Contact for further information about the Medcin 400 Gas Incinerator, a pre-assembled incinerator
designed for rural and small-scale health care waste management.
PAHO (Pan American Health Organization)
Pan American Sanitary Bureau, Regional Office of the World Health Organization, 525 Twenty-third
Street, N.W. Washington, D.C. 20037, USA
Tel: 1 202 974-3000, fax: 1 202 974-3663, website: www.paho.org/
The Pan American Health Organization (PAHO) is an international public health agency working to
improve health and living standards of the countries of the Americas. It also serves as the Regional
Office for the Americas of the World Health Organization.Antonio Hernandez is the contact for
healthcare technology issues, email: 1hernana@paho.org
251
Quality Assurance Research and Policy Development Group (QARPDG)

Philippine Health Insurance Corporation (PhilHealth), CityState Center, 709 Shaw Blvd., Brgy.
Oranbo, 1600 Pasig City, Philippines
Fax: 632 637 9693, emailmadz_valera@yahoo.com, contact: Dr. Madeleine Valera (Vice President)
PhilHealth is a government owned and controlled corporation that was the main organizer of the 3rd
Asian Regional Health Technology Assessment Conference in 2004, and is the source for the
conference proceedings.
RS Components Ltd.
Birchington Road, Corby, Northants, NN17 9RS, UK
Tel: 44 1536 201234, fax: 44 1536 405678, email: general@rs-components.com, website: rswww.com
Supplier of equipment, supplies, parts, and components for a wide range of engineering professions
such as electrical, electronic, mechanical, heating, ventilation, air-conditioning, plumbing, welding,
pneumatics, computing, automotive. Also a source of textbooks, technical data books, technical
literature, and training videos for all these engineering fields.
Source (International Information Support Centre)
The Wellcome Trust Building, Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
Tel: 44 20 7242 9789 ext 8698, fax: 44 20 7404 2062, email: source@ich.ucl.ac.uk,
website: www.asksource.info
The Source Centre has a unique collection of over 20,000 health and disability related information
resources. These include books, manuals, reports, posters, videos, and CD-Roms. Many materials are
from developing countries and include both published and unpublished literature.
SpaceLabs Medical Inc
15220 N.E. 40th Street, Redmond, WA 98052, USA
Tel: 1 206 882 3700, website: www.spacelabs.com/
Spacelabs Medical is a leading global provider of patient monitoring and clinical information systems.
Their educational service produces a Biophysical Measurement Book Series for biomedical and
clinical professionals
Swiss Centre for Development Cooperation in Technology and Management (SKAT).
Website: www.skat.ch/dc/publ/publ.htm
SKAT works internationally in the areas of water and sanitation, architecture and building, transport
infrastructure, and urban development. They also publish the SKAT newsletter
Swiss Centre for International Health (SCIH)
Swiss Tropical Institute, Socinstrasse 57, PO Box, CH-4002 Basle, Switzerland
Tel: 41 61 284 82 79, fax: 41 61 271 86 54, email: martin.raab@unibas.ch,
website: www.sti.ch/francais/scih/scih.htm
Undertakes consultancies in healthcare technology management in developing countries and
countries in transition.
TALC (Teaching Aids at Low Cost)
PO Box 49, St. Albans, Herts, AL1 5TX, UK
Tel: 44 1727 853869, fax: 44 1727 846852, email: talc@talcuk.org website: www.talcuk.org/
UK registered non-profit charity specialising in supplying affordable books, slides and teaching aids on
health and community issues in developing countries, with a particular focus on materials for PHC
and district levels.
Third World Network
email: twnet@po.jaring.my, website: www.twnside.org.sg
The Third World Network is an independent non-profit international network of organizations and
individuals involved in development issues. Its website offers articles and position papers on a variety
of subjects related to developing countries, including trade, health, biotechnology and bio-safety.
252
Transaid (Transport for Life)

137 Euston Road, London, NW1 2AA, UK
Tel: 44 20 7387 8136, fax: 44 20 7287 2669, email: info@transaid.org website: www.transaid.org
A charity working in the field of international transport management. Thus unique organization works
with many sectors, including health, to ensure that transport resources are efficiently and effectively
used. Their aim is to develop local capacity in transport and logistics management. They produce a
newsletter Hub and spoke, and have developed the Transaid transport management handbook.
Tropical Health Technology (THT)
14 Bevills Close, Doddington, March, Cambridgeshire PE15 OTT, UK
Tel: 44 1354 740825, fax: 44 1354 740013, email: thtbooks@tht.ndirect.co.uk, website:
www.tht.ndirect.co.uk
Charity concerned with supporting and improving laboratory services in the developing world. Primary
focus is laboratory services, information and technology. Specializes in supply of laboratory equipment,
books, bench aids, slide sets and microscopes.
UNICEF (United Nations Children’s Fund)
UNICEF House, 3 UN Plaza, New York 10017, USA
Tel: 1 212 326 7000, fax: 1 212 887 7454, email: jando@unicef.org, website: www.unicef.org
It provides a wide range or resource materials, journals, books and videos, games and posters for
children’s programmes. Your regional or field office will offer advice on all aspects of child health care
and UNICEF materials – contact details are on the website. The goods contained in UNICEF’s
Supply catalogue are supplied by the UNICEF Supply Division, UNICEF Plads, Freeport, 2100
Copenhagen OE, Denmark. Tel: 45 3527 3527, fax: 45 3526 9421, email: supply@unicef.org.
World Bank (WB)
www.worldbank.org
One of the world’s largest sources of development assistance including health, nutrition and
population projects
World Council of Churches (WCC)
PO Box 2100, 1211 Geneva, Switzerland
Tel: 41 22 791 6111, fax: 41 22 791 0361, email: info@wcc-coe.org, website: www.wcc-coe.org
International fellowship of churches that produces publications and newsletters. Recent publications
include Guidelines on medical equipment donations.
World Health Organization (WHO)
20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Tel: 41 22 791 2476 or 2477, fax: 41 22 791 4857, website: www.who.int/en/
WHO offers advice, and undertakes programmes, on all aspects of health care. Contact your regional
or field office for advice on all aspects of health care and WHO materials - the addresses of the
regional offices worldwide are available on the website.
i. WHO has programmes and literature on many aspects of healthcare technology management.
Andrei Issakov, Coordinator of Health Technology and Facilities Planning and Management, is the
contact, and source of WHO literature on healthcare technology management that is not available
as published documents, email: issakova@who.int.
ii. WHO produces and distributes books, manuals, journals, practical guidelines and technical
documents, several include aspects of healthcare technology management. The Distribution and
Sales Office is the contact point for information on WHO publications, email:
publications@who.ch, website: www.who.int/publications/en/. To order WHO publications use
email: bookorders@who.int.
iii. WHO has a comprehensive library and information service on international public health
literature. Contact email: library@who.int. The WHO library catalogue has electronic access to
more than 4000 technical documents, use website: www.who.int/library.
iv. WHO produces many newsletters, for a list contact website:
www.who.int/library/reference/information/newsletters/index.en.shtml
253
Ziken International Consultants Ltd

Causeway House, 46 Malling Street, Lewes, E.Sussex, BN7 2RH, UK
Tel: 44 1273 477474, fax: 44 1273 478466, email: info@ziken.co.uk, website: www.ziken.co.uk
A consultancy organization working worldwide in many aspects of health care development, including
healthcare technology management.
See Guide 1 or 5 for information on training institutes and international professional bodies for
different aspects of clinical and hospital engineering. Also see all other Guides in the Series for
journals and training resources specific to the topics covered by each Guide.
254
Annex 3: Typical equipment lifetimes
ANNEX 3: TYPICAL EQUIPMENT LIFETIMES

Different organizations have tried to estimate typical equipment lifetimes for healthcare technology.
This annex contains the results from two different sources – the American Hospital Association, and
the GTZ (German Government Technical Aid Agency).
LIST 1: The American Hospital Association (AHA)

Source: American Hospital Asso.ciation, 1998, ‘Estimated Useful Lives of Depreciable Hospital Assets’, American Hospital
Association, Chicago, USA
The AHA’s extensive list reflects how equipment lasts within the United States’ healthcare system,
whether it was manufactured in the US or abroad.
Their list was compiled following:
◆ discussions with manufacturers of healthcare equipment
◆ discussions with various hospital department managers
◆ analysis of actual retirement practices for actual hospital assets.
Their list is made up of a series of tables of different categories of equipment determined by the
equipment’s role in the health facility.
Part One: Estimated Useful Lives of Land Improvements, Buildings, and

Fixed Equipment
Table 1: Land Improvements

Land improvements are assets of an above-ground or below-ground nature, found in the land area contiguous to
and designed for serving a health care facility. The asset cost would include a proportionate share of
architectural, consulting, and interest expense for newly constructed or renovated facilities.
Item Years Item Years
Bumpers 5 Paving (including roadways, walks,
Culverts 18 and parking) (continued)
Brick 20
Fencing
Concrete 15
Brick or stone 25
Gravel 5
Chain-link 15
Wire 5 Retaining wall 20
Wood 8 Shrubs and lawns 5
Flagpole 20 Signs, metal or electric 10
Guard rails 15 Snow-melting system 5
Heated pavement 10 Trees 20
Landscaping 10 Turf, artificial 5
Lawn sprinkler system 15 Underground utilities
Parking lot, open-wall 20 Sewer lines 25
Water lines 25
Parking lot gate/s 3
Waste water treatment system 20
Parking lot striping 2
Water wells 25
Paving (including roadways, walks,and parking)
Asphalt 8 Yard lighting 15
255
Table 2: Buildings
Buildings are structures consisting of building shell, exterior walls, interior framings, walls, floors, and ceilings.
The asset cost would include a proportionate share of architectural, consulting, and interest expense for newly
constructed or renovated facilities. In assigning the estimated useful lives in this table, the following factors
were considered: the type of construction, the functional utility of the structure, recent regulatory or
environmental changes, and the general volatility of the health care field.
Boiler house 30 Metal-clad building 20
Garage Multilevel parking structure 25
Masonry 25 Reinforced concrete building,
Wood frame 15 common design 40
Guardhouse 15 Residence
Masonry building, reinforced Masonry 25
concrete frame 40 Wood frame 25
Masonry building, steel frame Storage building
Fireproofed 40 Masonry 25
Nonfireproofed 30 Metal garden-type 10
Masonry building, wood/metal frame 25 Wood frame 20
Table 3: Building Components

Building components are assets that are a part of the building shell or interior construction. The asset cost would
include a proportionate share of architectural, consulting, and interest expense.
Canopies 15 Floor finishes (continued)
Carpentry work 15 Quarry 20
Sealer 5
Caulking 5
Terrazzo 15
Sealants 5 Vinyl 10
Ceiling finishes Folding partitions 10
Acoustical 8
Loading dock bumpers and levelers 10
Gypsum 10
Plaster 12 Magnetic/MRI shielding 10
Computer flooring 10 Millwork 15
Corner guards 10 Overhead doors 10
Cubicle tracks 10 Partitions, interior 15
Designation signs 5 Partitions, toilet 15
Doors and frames Railings
Automatic 10 Freestanding (exterior) 15
Hollow metal 20 Handrails (interior) 15
Wood 15 Roof covering 10
Drapery tracks 10 Skylights 20
Drilled piers 40 Storefront construction 20
Floor finishes Wall covering
Carpet 5 Paint 5
Ceramic 20 Wallpaper 5
Concrete 20 X-ray protection 10
Hardwood 10
256
Table 4: Fixed Equipment

Fixed equipment includes assets that are permanently affixed to the building structure and are not subject to
movement but have shorter useful lives than that of the building. The asset cost would include a proportionate
share of architectural, consulting, and interest expense.
Benches, bins, cabinets, counters, Laminar flow system 15
and shelving, built-in 15 Lockers, built-in 15
Cabinet, biological safety 15 Mailboxes, built-in 20
Canopy-ventilating for laundry ironer 15 Medicine preparation station 15
Central dictation system 10 Mirrors, traffic and/or wall mounted 10
Coat rack 20 Narcotics safe 20
Conveyor system, laundry 10 Nurses’ counter, built-in 15
Cooler, walk-in 15 Pass-through boxes 15
Curtains and drapes 5 Patients’ consoles 15
Emergency generator set 20 Patients’ wardrobes and vanities, built-in 15
Generator controls 12 Projection screens 10
Hood, fume 15 Sink and drainboard 20
Fire protection in hoods 10 Sterilizer, built-in 15
ICU and CCU counters 15 Telephone enclosure 10
Illuminator
Multifilm 10
Single 10
Table 5: Building Services Equipment (overleaf)

Building services equipment refers to mechanical components or systems designed for the building(s), including
air conditioning, electrical elevators, heating lighting plumbing sprinklers, and ventilating. The asset cost would
include a proportionate share of architectural, consulting and interest expense for newly constructed or
renovated facilities.
257

Air-condition equipment Fire protection system
Centrifugal chiller 15 Fire alarm system 10
Compressor, air 15 Fire pump 20
Condensate tank 10 Smoke and heat detectors 10
Condenser 15 Sprinkler system 25
Controls 10 Tank and tower 25
Cooler and dehumidifier 10 Furnace, domestic 15
Cooling tower, concrete 20 Heating, ventilating, and air conditioning
Wood 10 (composite system) 15
Duct work 20 Heat pump system 10
Fan, air-handling and ventilating 20 Humidifier 15
Metal 20
Incinerator, indoor 10
Piping 20
Insulation, pipe 15
Precipitator 10
Pump 10 Intercom system 10
Air-conditioning system Laboratory plumbing, piping 20
Large (over 20 tons) 10 Magnetic door holders 10
Medium (5-20 tons) 10 Medical gas system (composite system) 15
Small (under 5 tons) 5 Nurse call system 10
Air curtain 15 Oil storage tank 20
Antenna system 10 Oxygen, gas, and air piping 20
Boiler 20 Paging system 20
Deaerator system 15 Physicians’ in-and-out register, built-in 10
Boiler smokestack, metal 20 Plumbing, composite 20
Clean-air equipment 15 Fixtures 20
Piping 25
Clock system, central 15
Pump 15
Co-generation plant, generator powered 15 Pneumatic tube system 15
Door alarm 10 Radiator
Door-closing devices, for fire alarm system 15 Cast-iron 25
Electric lighting and power Finned tube 15
Composite 18 Sewerage, composite 25
Conduit and wiring 20 Piping 20
Emergency lighting system 15 Sump pump and sewerage ejector 10
Feed wiring 20 Solar heating equipment 10
Fixtures 10 Surge suppression system 15
Switch gear 15 Telephone system 10
Transformer 30
Television antenna system 10
Elevator Television satellite dish 10
Dumbwaiter 20
Temperature controls, computerised 10
Freight 20
Passenger, high-speed automatic 20 Unit heater 10
Passenger, other 20 Vacuum cleaning system 15
Emergency generator 20 Water fountain 10
Controls 12 Water heater, commercial 10
Water purifier 10
Energy management system, computer based 10
Water softener 10
Escalator 20
Water storage tank 20
Fans, ceiling-mounted 10
Water wells 25
258
Part Two: Estimated Useful Lives of Major Movable Equipment

Major movable equipment is defined as assets that are generally assigned to a specific department within the
health care facility, but with the capacity of being relocated. The assets have a minimum useful life of at least
three years and a unit cost sufficiently large to justify the expense of maintaining an equipment ledger.
Note: Included within the departmental listings are assets that may be considered to be minor equipment (for
example, surgical instruments with a three-year life assignment). Minor equipment may be defined as assets
that are relatively small in size and unit cost and have high usage. They are generally found in the obstetrics,
surgery, and dietary departments.
Table 6: Administrative Departments

Administrative Departments consist of administration, barber shop, board room, admitting, business office,
communications, data processing, education, facilities management, finance, foundation, graphics, home health,
human resources infection control, library, lobby, marketing, medical education, medical records, medical staff
facilities, nursing administration, pastoral care, patient education, physician on-call rooms, public relations,
quality assessment and improvement, social services, and volunteer services departments.
Beepers, paging 3 Computer printer 5
Bench, metal or wood 15 Computer software 3
Binder, punch machine 10 Computer terminal 5
Bookcase, metal or wood 20 Credenza 15
Bulletin board 10 Data printing unit 5
Cabinet file, metal or wood 15 Data storage unit
Camera 5 Mechanical 10
Nonmechanical 15
Cathode-ray tube (CRT) 3
Data tape processing unit (including
Chair
controller, drive, and tape deck) 5
Arm 15
Conference 15 Desk, metal or wood 20
Executive 15 Dictating equipment 5
Folding 10 Display cases 20
Guest 15
Duplicator 5
Side 15
Facsimile transmitter 3
Check signer 10
Files 15
Clock 10
Electric rotary 15
Collator, electric 10 Legal 15
Computer Regular 15
Laptop 3 Filing system, portable 20
Large 5
Imprinter
Micro 5
Address 5
Mini (personal) 3
Embossed plate 10
Computer disk drive 5
Integrator 10
Computer networking equipment
Intercom 10
Controller 5
Hub 5 Label maker 10
Modem 5 Library furniture 20
Mux unit 5 Mailing machine 10
Server 5 Microfilm unit 10
Token ring 5
Continued overleaf
259
Table 6: Administrative Departments (continued)

Microphone 5 Shelving, portable, steel 20
Microprojector 10 Sofa 12
Stamp Machine 10
Organ 10
Stapler, electric or air 10
Paper burster 8
Stencil machine 10
Paper cutter 10
Stereo equipment 5
Paper shredder 5
Table
Paper shredder 5 Folding 10
Partitions, movable office 10 Metal or wood 15
Photocopier Television receiver 5
Small 3 Time recording equipment 10
Large 5
Transcribing equipment 5
Piano 20
Typewriter, electric 5
Projector
Valet, office 15
Overhead 10
Slide 10 Video cassette recorder/player 5
Video 5 Walkie-talkie 5
Recorder, tape 5 Water cooler, bottle 10
Safe 20 Word processor
Scale, postal 10 Large 5
Small 5
Screen, projector 10
Work station 10
Settee 12
Table 7: Nursing Departments

Nursing departments consist of cardiac care, chemical dependency, intensive care, medical/surgical care,
neonatal intensive care, nursery, pediatrics, pediatric developmental disabilities, and psychiatric units.
Bassinet 15 Cabinet
Bath Bedside 15
Sitz 10 File 15
Whirlpool 10 Instrument 15
Metal or wood 15
Bed
Pharmacy 15
Birthing 15
Solution 15
Electric 12
X-ray 15
Flotation therapy 10
Hydraulic 15 Central supply furniture 15
Labor 15 Chair
Manual 15 Blood drawing 10
Orthopedic 15 Dental 15
Bench, metal or wood 15 Executive 15
Bin, metal or wood 15 Folding 10
Geriatric 10
Blood pressure device, electronic 6
Hydraulic, surgeon’s 15
Bookcase, metal 20
Continued opposite
260
Table 7: Nursing Departments (continued)

Chair (continued Operating stool 15
Kinetron 15 Ophthalmoscope 10
Podiatric 15 Osmometer 7
Shower/bath 10 Otoscope 7
Specialist’s 15
Ottoman 10
Chart rack 20
Patient monitoring equipment 10
Chart recorder 10
Phototherapy unit 10
Clothes locker
Physicians’ in-and-out register, portable 10
Fibreglass or metal 15
Physiological monitor 7
Liminate or wood 12
Pump, breast 10
Computer, caridial output 5
Scale, baby 15
Credenza 15
Settee 12
Crib 15
Shelving, portable, steel 20
Croupette 10
Sofa 12
Defibrillator 5
Stall Bars 15
Desk, metal or wood 20
Table
Doppler 5 Anesthetic 15
Dresser 15 Autopsy 20
Food service furniture 15 Electrohydraulic tilt 10
Frame, turning 15 Examining 15
Folding 10
Housekeeping furniture 15
Food preparation 15
ICU and CCU furniture 15 Fracture 15
Infant care center 10 Instrument 15
In-service education furniture 15 Light 15
Metal 15
Insufflator 5
Obstetrical 20
Labor and delivery furniture 15 Operating 15
Laboratory furniture 15 Orthopedic 10
Lamp Overbed 15
Bilirubin 10 Pool 10
Emergency 10 Refrigerated 10
Lawn and patio furniture 5 Therapy 15
Traction 10
Light
Urological 15
Delivery 15
Wood 15
Examining 10
Portable, emergency 10 Telemetry unit, cardiac 5
Natural childbirth backrest 10 Thermometer, electric 5
Nursing service furniture 15 Ultrasonic fetal heart monitor 7
Operating room furniture 15 Work station 10
261
Table 8: Diagnostic and Treatment Departments

Diagnostic and treatment departments consist of ambulatory surgery, anesthesia, cardiac rehabilitation,
catheterization laboratory, CT scan, ECT, EEG/EMG, emergency, employee health, enterostomal therapy, GI
laboratory, hemodialysis, hyperbaric medicine, in vitro medicine, IV therapy, inpatient pharmacy, laboratory,
lithotripsy, mobile air care, medical oncology, MRI, noninvasive cardiology, obstetrics, occupational therapy,
physical therapy, postanesthesia care unit, radiation therapy, radiology, respiratory therapy, speech therapy, and
surgery departments.
Accelerator 7 Blood gas analyzer 5
Alternating pressure pad 10 Blood gas apparatus, volumetrics 8
Amino acid analyzer 7 Blood transfusion apparatus 6
Amplifier 10 Blood warmer 7
Anaerobe chamber 15 Blood warmer coil 7
Analyzer, haematology 7 Bone surgery apparatus 3
Anatomical model 10 Breathing unit, positive-pressure 8
Anesthesia unit 7 Bronchoscope
Ankle exerciser 15 Flexible 3
Rigid 3
Apnea monitor 7
Carbon monoxide recorder/detector 10
Apron, lead-lined 47
Cardiac monitor 5
Arthroscope 5
Cardioscope 8
Arthroscopy instrumentation 3
Cart
Aspirator 10
Emergency-isolation 10
Audiometer 10 Medicine 10
Autoclave 10 Caspar ACF instrument and plate system 7
Autoscaler, ionic 10 Cassette changer 8
Bacteriology analyzer 8 Cautery unit
Baci incinerator 5 Dermatology 7
Balance Gynecology 7
Analytical 10 Cell freezer 7
Electronic 7 Cell washer 5
Precision mechanical 10
Centrifuge 7
Basal metabolism unit 8
Centrifuge, refrigerated 5
Bath
Cerebral function monitor 7
Fluidotherapy 7
Paraffin 7 Child immobilizer 15
Serological 7 Chloridiometer 10
Water 7 Chromatograph, gas 7
Biochemical analysis unit 7 Clinical analyzer 5
Biochromatic analyzer 7 Clopay wrapping machine 10
Biofeedback machine 8 Coagulation analyzer 5
Biomagnetometer 7 Cold-pack unit, floor 10
Bipolar coagulator 7 Colonoscope 3
Blood cell counter 5 Colorimeter 7
Blood chemistry analyzer, automated 5 Colposcope, with floor stand 8
Blood culture analyzer 8 Computer, clinical 5
Continued opposite
262
Table 8: Diagnostic and Treatment Departments (continued)

Computer-assisted tomography (CT) scanner 5 Exercise equipment, outdoor 10
Conductivity tester 5 Exercise system, computer assisted 5
CO-oximeter 10 Exerciser, orthotron 10
Cryoopthalmic unit, with probes 7 Eye surgery equipment (phacoemulsifier) 7
Cryostat 7 Fiberoptic equipment 5
Cryosurgical unit 10 Fibrometer 7
Cyclotron 7 Film changer 8
Cystic fibrosis treatment system 10 Film viewer 10
Cystometer 10 Flow cytometer 5
Cystometrogram unit 10 Fluid sample handler 5
Cystoscope 3 Fluorimeter 10
Decalcifier 10 Fluoroscope 8
Deionized water system 7 Frame, turning 15
Densitometer, recording 5 Furnace, laboratory 10
Dental drill, with syringe 3 Gamma camera 5
Dermatome 10 Gamma counter 7
Diagnostic set 10 Gamma knife 10
Diathermy unit 10 Gamma well system 7
Digital fluoroscopy unit 5 Gas analyzer 8
Digital radiography unit 5 Gastroscope 3
Diluter 10 Geiger counter 10
Dispenser, alcohol 10 Generator 5
Distilling apparatus 15 Gloves, lead-lined 3
Doppler 5 Hand dynamometer 10
Dose calibrator 5 Heart-lung system 8
Dryer, sonic 10 Heat sealer 5
Duodenoscope 3 Hemodialysis unit 5
Echocardiograph system 5 Hemoglobinometer 7
Echoview system 5 Hemophotometer 10
Electrocardiograph 7 High-density mobile film system 10
Electrocardioscanner Holter
(Holter monitor scanner) 7 Electrocardiograph 7
Electroencephalograph 7 Electroencephalograph 7
Electrolyte analyzer 5 Homogenizer 10
Electromyograph 7 Hood, exhaust or Bacti 10
Electrophoresis unit 7 Hydrocollator 10
Electrosurgical unit 7 Hydrotherapy equipment 15
Ergometer 10 Hyfrecator 10
Evacuator 10 Hyperbaric chamber 15
Evoked potential unit 10 Hypothermia apparatus 10
Exercise apparatus 15 Image analyzer 5
Continued overleaf
263

Image intensifier 5 Nebulizer
Immunodiffusion equipment 10 Pneumatic 10
Ultrasonic 10
IMX analyzer 7
Nephroscope 7
Incubator, laboratory 10
Neurological surgical table headrest 10
Inhalator 10
Neutron beam accelerator 8
Intraarterial shaver 10
Noninvasive CO2 monitor 7
Iontophoresis unit 8
Optical readers 5
Isodensitometer 7
Orthotron system 10
Isolation chamber 12
Orthourological instruments 10
Isotope equipment 7
Oscilloscope 7
Isotope scanner 7
Oven
Kiln 10
Paraffin 10
K-pads 5 Sterilizing 10
Kymograph 10 Oximeter 10
Lamp Oxygen analyzer 7
Deep-therapy 10
Oxygen tank, motor, and truck 8
Infrared 10
Mercury quartz 10 Pacemaker, cardiac (external) 5
Slit 10 Pacing system analyzer 7
Laparoscope 3 Panendoscope 10
Laryngoscope 3 Parallel bars 15
Laser, coronary 2 Pelviscope 7
Laser, surgical 5 Percussor 5
Laser positioner 5 Perforator 10
Laser smoke evacuator 5 Peripheral analyzer 10
Lifter, patient 10 pH gas analyzer 10
Linac scalpel 5 pH meter 10
Linear accelerator 7 Phonocardiograph 8
Lithotripter, extracorporeal shock-wave (ESWL) 5 Photocoagulator 10
Magnetic resonance imaging (MRI) equipment 5 Photography apparatus, gross pathology 10
Mammography unit Photometer 8
Fixed 5 Physioscope 10
Mobile (van) 8 Pipette, automatic 10
Marograph 7 Plasma freezer 10
Mass spectrophotometer 7 Platelet rotator 20
Microbiology analyzer 8 Positron emission tomography
Microscope 7 (PET) scanner 5
Microtome 7 Proctoscope 3
Microtron power system 7 Prothrombin timer, automated 8
Mirror, therapy 15 Proton beam accelerator 7
Muscle stimulator 10 Pulmonary function analyzer 8
Continued opposite
264

Pulmonary function equipment 8 Slide stainer, laboratory 7
Pulsed oxygen chamber 10 Spectrophotometer 8
Pulse oxymeter 7 Spectroscope 10
Pump Sphygmomanometer 10
Infusion 10 Spirometer 8
Stomach 10
Stand
Suction 10
Basin 15
Surgical 10
Intravenous 15
Vacuum 10
Irrigating 15
Radiation meter 8 Mayo 15
Radioactive source, cobalt 5 Steam-pack equipment 10
Radiographic duplicating printer 8 Stereo tactic frame 5
Radiographic-fluoroscopic combination 5 Sterilizer, movable 12
Radiographic head unit 5 Steris sterilization system 7
Rate meter, dual 10 Stethoscope 5
Refractometer 10 Stress tester 10
Refrigerator, blood bank 10 Stretcher 10
Resuscitator 10 Hydraulic 7
Retractor 5 Surgical shaver 5
Rhinoscope 3 Tank
Rinser, sonic 10 Cleaning 10
Full-body 15
Rotoosteotome unit 10
Hot-water 10
Saw Therapy 15
Autopsy 10
TDX analyzer 7
Neurosurgical 10
Surgical, electric 10 Telemetry unit, cardiac 5
Scale Telescope, microlens 10
Bed 10 Telescopic shoulder wheel 15
Chair 10 Telethermometer 10
Clinical 10
Tent
Scale, metabolic 10 Aerosol 8
Scintillation scaler 8 Oxygen 8
Sensitometer 10 Thyroid uptake system 5
Seriograph, automatic 8 Tissue-embedding center 8
Shaking machine (vortexer) 8 Tissue processor 7
Sharpener, microtome knife 10 Titrator, automatic 10
Sigmoidoscope 3 Tonometer 10
Signal-averaged EKG 5 Totalap 10
Simulator 5 Tourniquet, automatic 10
Single-photon emission computed tomography Tourniquet system 7
(SPECT) Scanner 5 Traction unit 10
Sinuscope 7 Transcutaneous nerve stimulator system 5
Skelton 10 Transesophageal transducer 5
Continued overleaf
265

Treadmill, electric 8 Wheelchair 5
Tube dryer 10 X-ray equipment
Tube tester 10 Developing tank 10
Film dryer 8
Ultrasound, diagnostic 5
Film processor 8
Ultrasound unit, therapeutic 7 Furniture 15
Vacuvette 10 Image intensifier 5
Ventilator, respiratory 10 Intensifying screens 5
Silver recovery unit 7
Vial filler 10
X-ray unit
Vibrator 10
Fluoroscopic 5
Video Mobile 5
Camera 5 Radiographic 5
Light source 5 Superficial therapy 5
Monitor 5 Tomographic 5
Printer 5 Wiring 5
Table 9: Support Departments

Support departments consist of biomedical engineering, central sterile supply, dietary, engineering/maintenance,
housekeeping/environmental services, laundry, materials management, security, and staff facilities departments.
Air conditioner, window 5 Cart
Ambulance 4 Food/tray, heated-refrigerated 10
Linen 10
Automobile
Maid 10
Delivery 4
Supply 10
Passenger 4
Utility 10
Battery charger 5
Cash register 5
Bedpan washer 15
Central data processing unit 10
Blanket dryer 15
Clock 10
Blanket warmer 15
Coffee maker 5
Bottle washer 10
Compactor, waste 10
Broiler 10
Compressor, air 12
Burnisher, silverware 15
Conveyor, tray 10
Cage, animal 10
Cooker, pressure, for food 10
Camera, identification 5
Cooler, walk-in, freestanding 15
Camera, surgical 5
Cutter, cloth, electric 10
Camera, television monitoring,
Cutter, food 10
color or black-and-white 5
Dish sterilizer 10
Camera, videotape, color or black-and-white 5
Dishwasher 10
Can opener, electric 10
Disinfector 15
Capsule machine 10
Continued opposite
266
Table 9: Support Departments (continued)

Dispenser Lint collector 15
Butter, refrigerated 10 Loom 15
Milk or cream 10 Lowerator 10
Drill press 20 Mannequin 10
Dryer Marking machine 10
Clothes 10 Meat chopper 10
Hair 5 Mixer, commercial 10
Drying oven, paint shop 10 Nourishment ice station 8
Enlarger 10 Oven
Extractor, laundry 15 Baking 10
Microwave 5
Floor-buffing and polishing machine 5
Roasting 10
Floor-scrubbing machine 5
Packaging machine 10
Floor-waxing machine 5 Platform 12
Folder, flatwork 15 Paint spray booth 15
Food chopper 10 Paint-spraying machine 10
Freezer, ultracold 10 Paper baler 15
Fryer, deep-fat 10 Parking lot sweeper 5
Garbage disposal, commercial 5 Pipe cutter-threader 10
Glassware washer 8 Planer and shaper, electric 10
Griddle 10 Plate-bending press 10
Grinder, food waste 10 Platemaker
Helicopter 4 Computerized 5
Hoist, chain or cable 15 Noncomputerized 10
Hot-food box 15 Popcorn machine 8
Hotplate 5 Power supply 10
Humidifier 8 Press, laundry 15
Ice cream freezer 10 Printing press 10
Ice cream (soft) machine 10 Range, domestic 10
Refrigerator
Ice cream storage cabinet 10
Domestic 8
Ice cube-making equipment 10 Commercial 10
Indicator, remote 10 Undercounter 10
Intercom 10 Remote control receiver 10
Ironer, flatwork 15 Rotary tiller 10
Kettle, steam-jacketed 15 Sanitizer 10
Key machine 10 Saw
Laminator 10 Band 10
Lathe 15 Bench, electric 10
Lawn mower, power 3 Meat-cutting 10
Linen press 15 Scaffold 10
Linen table 15 Scale, laundry
Linen washer 15 Movable 10
Platform 15
Continued overleaf
267
Table 9: Support Departments (continued)

Sewing machine 15 Truck (hand)
Shears, squaring, floor 12 Hot-food 10
Tray 12
Shoulder wheel 20
Ultrasonic cleaner 10
Simulator 5
Urn, coffee 10
Slicer
Vacuum cleaner 8
Bread 10
Vegetable peeler, electric 10
Meat 10
Vending machine 10
Snowblower 5
Vise, large bench 20
Steamer, vegetable 10
Warmer
Telephone, cordless 5
Dish 10
Telephone equipment for deaf 5 Food 10
Telephone monitors 10 Washing machine
Telephone system 10 Commercial, small 10
Television monitor 5 Domestic 10
Linen, large 15
Television receiver 5
Welder 10
Toaster, commercial 10
Wire tightener-twister 10
Tractor 10
Truck (automotive)
Forklift 10
Multipurpose filling 15
Pickup 4
Van 4
268
LIST 2: The GTZ (German Government Technical Aid Agency)

Source: Halbwachs, H (GTZ), 2000, ‘Maintenance and the Life Expectancy of Healthcare Equipment in Developing
Economies’, in Health Estate Journal, March 2000, pp 26-31
The GTZ list contains estimates for fewer equipment items, but it more closely reflects the realities
in developing countries.
The GTZ used a particular research method (a Delphi survey – see source paper) to obtain and
analyze feedback from 23 experts from 16 different country backgrounds. The experts were made up
of hospital engineers, bio-medical engineers, a public health doctor/manager, health physicists, and a
health economist. Rather than providing exact lifetimes, this approach provides a range for the
lifetime that depends on the quality of the initial equipment and how well it has been maintained.
Reproduced here is a table containing a summary of their findings.
Table Summarizing GTZ’s Findings

Lifetime in years
Equipment type Poor quality makes Good quality makes
Poorly Well Poorly Well
maintained maintained maintained maintained
Air-conditioner
(window type) 3 5–7 5–6 10 – 12
Anaesthetic machine
(Boyles) 2–5 5 – 10 5 – 10 10 – 15
Centrifuge 3–4 7–8 6–9 10 – 12
Generator (diesel) 3–6 9 – 10 10 – 12 18 – 20
Generator (petrol) 2–5 5 – 10 6 – 15 10 – 20
Microscope 3–6 5 – 10 6 – 10 10 – 20
Oven, hot air (laboratory) 2–6 5–8 6 – 10 10 – 15
Refrigerator (electrical) 3–5 5–8 5–8 10 – 15
Refrigerator (kerosene) 4 4–8 5 – 10 10 – 17
Sphygmomanometer
(aneroid) 1–3 2–3 2–5 5 – 10
Sphygmomanometer
(mercury) 1–2 3–5 3-5 8 – 10
Sterilizer, bench-top
(horizontal) 3–5 5–8 6 – 10 10 – 14
Sterilizer, floor-standing
(vertical) 3–6 5 – 12 8 14 – 15
Suction pump (electrical) 1–3 5–7 5–8 10 – 15
Truck, pick-up 2–4 3–6 4–8 7 – 12
Washing machine
(electrical) 2–4 5 6 8 – 11
269
Annex 4: Sample long generic equipment specification
ANNEX 4: SAMPLE LONG GENERIC EQUIPMENT

SPECIFICATION
This annex contains an example of a long generic specification. In Guide 3 there is an example of a
shorter one, for an operating table.
SPECIFICATION FOR AN INFANT INCUBATOR
1. APPLICABLE DOCUMENTS
The specification should be read in conjunction with the ‘Technical and Environmental Data Sheet’,
and all goods offered must conform to the details specified in it and be able to function in the
prevailing conditions described.
2. REQUIREMENTS
2.1 GENERAL DESCRIPTION
To supply: ONE x unit to provide a suitable environment conducive for nursing ill, premature, and
under weight babies.
2.2 OPERATIONAL REQUIREMENTS

Note: supplier to complete ‘Reply’ and ‘Remarks’ sections.
Reply Remarks
2.2.1 There shall be a trolley base with four swivel wheels,

at least two lockable.
2.2.2 The incubator shall fit securely onto the trolley.
2.2.3 The incubator base shall house the power

compartment, fan and humidifier tank.
2.2.4 The infant compartment shall have a base, mounted

above the humidifier tank and fan, which is large
enough to allow the unimpeded handling of the infant.
Base shall have smooth, easy to clean surfaces
2.2.5 The baby tray shall be mounted on the infant

compartment base and shall be tilt-able,
(Trendelenburg and reverse).
2.26 The baby tray shall be graduated along its length for
measuring the infant
2.2.7 The mattress will fit onto the baby tray, be

approximately 20mm thick, be not less than
64cm x 36cm and have a removable cover.
2.2.8 The infant compartment shall have a transparent

canopy that forms four sides and the roof.
Continued opposite
270
2.2 OPERATIONAL REQUIREMENTS (continued)
2.2.9 The canopy shall be hinged along one side so that it

can be swung up to provide free access to the bed.
2.2.10 The canopy shall be designed or secured so that it is

prevented from falling accidentally from the open
position
2.2.11 The canopy shall be sealed to the frame by means of

a non-porous rubber or plastic gasket.
2.2.12 The canopy shall be fitted with a drop down (or

swivel) access panel to allow the mattress to be
brought forward.
2.2.13 The canopy shall have five port doors, two on each
side and one at the front. They shall be hinged doors
or fitted with an iris-diaphragm type plastic cover. All
hand ports shall not be less than 127mm in diameter.
2.2.14 All openings with hinged doors shall have

closing latches.
2.2.15 The air shall be drawn into the incubator through an

easily removable bacteria filter capable of removing,
with an efficiency of 99%, particles of the size down
to 0.5 micron diameter
2.2.16 The air shall be circulated by means of a fan.
2.2.17 The circulated air shall maintain slight positive

pressure in the infant compartment such that enough
stale air escapes from the hood to prevent an
undesirable and dangerous carbon dioxide
accumulation inside blood.
2.2.18 The hood shall have inlet holes for access by oxygen
and feeding tubes.
2.2.19 The power compartment shall be of modular

construction and such that it can be withdrawn
for maintenance.
2.2.20 The power compartment will house a control panel

containing: -
On/off switch
Temperature display (digital)
Temperature display knob (manual)
High temperature alarm
Power failure alarm
Air flow alarm
Heat out-put indicator, "heat is on".
Continued overleaf
271
2.2.21 There will be an air temperature sensor mounted on

the inside of the canopy.
2.2.22 The incubator shall be equipped with heating

elements of the totally enclosed metal-clad type and
a thermostat capable of controlling the temperature
in the infant compartment over a specific
temperature range.
2.2.23 The incubator shall be equipped with a reliable pre-

set high temperature cut-out that operates
completely independently from the thermostat and
that disconnects the heating circuit from the
electricity supply if, as a result of heating from any
source (including direct sunlight or nearby heaters),
the temperature in the infant compartment exceeds
39 degrees Celsius. Any relay forming part of this
circuit shall be arranged to be fail-safe.
2.2.24 Temperature range of 34-39 degrees Celsius, in

increments of 0.1 degree.
2.2.25 At any setting of the thermostat, the temperature

overshoot during the warming-up period, relative to
the steady temperature reached, shall not exceed
1 degree Celsius.
2.2.26 The airflow alarm shall be activated if the airflow is

obstructed (due to fan failure or total air circulation
failure). The activation of the alarm shall cause a cut
off of the heating elements. It shall be mains
operated audible and visual.
2.2.27 The high temperature alarm shall be activated if air

temperature in the canopy exceeds 39 degrees
Celsius. It shall be mains operated audible and visual.
2.2.28 The power failure alarm shall give warning of any

interruption of the electric power supply to the
incubator. The alarm shall be operated from a battery
of the nickel cadmium type that is housed in the
power compartment and is continuously trickle
charged when the power is switched on. The alarm
shall be audible and visual.
2.2.29 Single phase power supply of 220-240 Vac, 50Hz.
2.2.30 To be able to withstand mains supply voltage

fluctuations of +/- 10%, and mains supply frequency
fluctuations of +/- 10%.
Continued opposite
272
2.2.31 The incubator shall be equipped with a 3 metre non-

kinking type flexible mains lead, fitted with a 3
(square) pin 13A plug. The mains connector to be
detachable locking type.
2.2.32 The humidifier tank will consist of a water reservoir,

water inlet port, and water outlet drain constructed
in such a way that once drained a residue puddle of
water cannot remain sitting in the reservoir.
2.3 PHYSICAL CHARACTERISTICS

Reply Remarks
2.3.1 The trolley to be of metallic tubular frame of such

dimensions and wall thickness as to give acceptable
strength and rigidity. It shall have a polyester powder
coating finish.
2.3.2 The casters will be of a minimum size of 100mm.
2.3.3 The incubator base shall be of metal construction

with a polyester powder coating finish.
2.3.4 The power compartment shall be of metal and so

designed that the mechanical and electrical
equipment within it is adequately protected against
mechanical damage and the ingress if water and
cleaning fluids.
2.3.5 There shall be an ignition proof barrier between the

infant compartment and the heating element and
other electrical components.
2.3.6 The canopy shall be of robust clear Perspex.
2.3.7 The bed tray and support shall be of corrosion

resistant material.
2.3.8 The mattress shall be of polyurethane (or other

acceptable) material.
2.3.9 Any metal attachments shall be chromium plated.
2.3.10 It should be possible to fully dismantle the

equipment for cleaning purposes; and all parts will be
easily cleaned.
273
2.4 SAFETY FEATURES

Reply Remarks
2.4.1 The unit must be manufactured to conform

to the IEC safety standard 60101 for medical
electrical equipment
2.4.2 Safety Classification: Type B
3. ACCESSORIES AND CONSUMABLES

Reply Remarks
3.1 The trolley base to contain a storage compartment

with latching doors.
3.2 An IV pole shall be attached to the trolley
3.3 An oxygen cylinder holder shall be attached to

the trolley
3.4 A shelf or holder will be attached to the trolley for

storage of baby feed.
3.5 A psychrometer will be attached to the canopy for

humidity measurement together with dry
thermometers and wet thermometers
3.6 Supply all necessaries for the unit to function

as described.
3.7 A list of each accessory and its cost must be stated.
3.8 State all consumables necessary for the unit to

function for two years.
3.9 A list of each consumable and its cost must be stated.
4. DOCUMENTATION
Reply Remarks
4.1 Supply an operating manual in English for

the machine.
4.2 Supply a service manual in English for the machine.
4.3 Supply a list of recommended spare parts required

for the maintenance of the machine, in English.
274
5. SPARE PARTS
Reply Remarks
5.1 Supply a set of only the recommended essential

spare parts for 24 months for maintenance and repair.
5.2 A list of each part and its price must be attached to

this bid.
6. DELIVERY
Reply Remarks
6.1 Package the machine with its accessories,

consumables, manuals and spare parts together in
one load.
6.2 Crate the goods for transport, and label it as follows:

1 x machine for health facility X.
6.3 • The cost of freighting the goods by sea and road

DDP to health facility X in country Y must
be stated.
• The cost of freighting the goods by air and road
DDP to health facility X in country Y must
be stated.
6.4 The cost of insuring the shipment for the full journey
must be stated.
7. INSTALLATION/COMMISSIONING/TRAINING
Reply Remarks
7.1 Full assembly and commissioning instructions must

be provided for assembly and commissioning by the
client, in a written format and as a video if available.
7.2 The cost of commissioning by the supplier or

representative must be stated.
7.3 State the cost of the supplier or representative

undertaking training and providing written
guidelines:
in operation – for users
in care and cleaning – for users
in PPM – for maintenance technicians
in repair – for maintenance technicians
7.4 Travel, accommodation and subsistence

requirements for undertaking the contract must
be stated.
275
8. WARRANTY
Reply Remarks
8.1 A guarantee period must be stated (a minimum of

12 months from the date of commissioning).
9. AFTER SALES SUPPORT

Reply Remarks
9.1 After sales support must be available in country Y or

in the region, with maintenance capabilities and
facilities, and spare parts stock holdings.
9.2 Details of the availability and location of spare parts

must be stated.
9.3 Details of the availability and location of

maintenance facilities must be stated.
9.4 The cost of the annual maintenance contract must

be stated, detailing the range/scope of such
maintenance work.
10. SUMMARY OF PRICES (detailed as follows:)

Reply Remarks
(total prices) (showing options
and alternatives)
1. Basic unit
2. Accessories as detailed
3. Optional accessories
4. Consumables
5. Documentation
6. Spare parts for maintenance and repair for 24 months
7.1 Crating
7.2 Delivery
7.3 Insurance
8.1 Commissioning
8.2 Training
9. Annual maintenance contract.
Note: supplier to attach to this summary:

◆ the lists of all accessories, consumables, spare parts, and manuals in the offer, showing their unit and total prices.
◆ the lists showing the breakdown of travel, accommodation, labour, subsistence, materials, and any other costs for
the installation/commissioning/training offered.
◆ the list showing the breakdown of the rates and costs of travel, accommodation, labour, subsistence, parts, and
any other items that apply to the maintenance contract during the warranty period, and post-warranty.
◆ the details describing after-sales support availability.
276
Annex: 5 Sample technical and environmental data sheet for suppliers
ANNEX 5: SAMPLE TECHNICAL AND ENVIRONMENTAL

DATA SHEET FOR SUPPLIERS
You can provide all tenderers, bidders, or suppliers with Technical and Environmental Information in
order to ensure that the equipment they are offering to supply conforms to the prevailing national or
local climate and conditions. The sample sheet in Box 56 contains examples of the sort of entries you
could include, which you can modify according to your own situation. Such a data sheet can be
developed for a country, a district, or a facility.
BOX 56: Sample Technical and Environmental Data Sheet for Suppliers
Example Entries for Health Facility X

Electricity Supply
Source: Mains / generating set / solar panels / none
Type: three-phase 550V, 50Hz / 380V, 50Hz
single phase 220V, 50Hz
etc
Fluctuation: There is some problem with:

a) mains fluctuation, approximately +– 10 per cent in both the voltage and
frequency supplied
b) mains cut-off (black out)
c) spikes, not necessarily on the mains supply but when large plant items cut in such
as lift motors
d) power only available for 2 hours a day
etc.
Suppliers should check/modify their power supply units if necessary, or state if voltage
stabilisers or a UPS is required alongside their products.
Water Supply
Quality: Hard water (high mineral or salt content) / soft water / sediment in water/ etc
Suppliers should check/modify their equipment with filters, softeners, or descalers if
necessary, or state if such units will be required alongside their products.
Pressure: 48psi, mains supply close at hand / pressure unknown – borehole supply / pressure
unknown – mains supply to subterranean tank
Problems: ◆ water supplies are frequently cut-off, or the electricity supply to the water pumps
is cut off
◆ very low pressure, or machines suddenly being without any water at all.
Suppliers should state if a back-up water storage tank or water pump is required with
their products
Continued overleaf
277
Annex: 5 Sample technical and environmental data sheet for suppliers
BOX 56: Sample Technical and Environmental Data Sheet for Suppliers (continued)
Example Entries for Health Facility X

Environment
Height above 4,500 – 5,000 feet where the health facility is located.
sea-level: Suppliers should check whether this will affect motors, pressure vessels, etc.
o
Temperature: ◆ Average temperature in winter inside health facility 16 C
o
◆ Average temperature in summer inside health facility 32 C
◆ There is no air-conditioning, even in the operating theatres.
Suppliers should state if air-conditioning is essential for the correct operation of
their products.
Humidity: High at 80 per cent. / very low and arid
Suppliers should check their products and, if necessary, carry out the following actions:
◆ tropicalize their printed circuit boards (provide them with a polymerized coating)
◆ replace rubber components which will perish with metal ones
◆ enclose silica gel or use other drying strategies
◆ use cotton not plastic
◆ use stainless steel or epoxy-coated metals which will not rust
etc.
Dust: There are problems with:
◆ dust getting into equipment and clogging up filters.
Suppliers should consider checking/modifying their equipment with additional course

filter protection.
Vermin: There are problems with:
◆ rats chewing through wiring
Suppliers should consider checking/modifying their equipment with metal vermin guards.
Manufacturing Quality
Standards: Equipment to conform to the relevant International Standards (IEC, ISO), or
otherwise to the relevant National Standards, which relate to the safe manufacture of
quality medical and hospital equipment.
Language
Language: All documents and manuals to be in English / French / Spanish or appropriate language
All labels and markings on machines to be in English / French / Spanish or appropriate
language.
Level of Technology of Equipment

Preferences ◆ more manual, less automatic
◆ more electro-mechanical, and less micro-processor controlled
◆ easily used and maintained
◆ robust
◆ to withstand the climate and conditions described above
◆ with technically-skilled after sales support available locally
etc.
278
Annex 6: Short-cut planning and budgeting when starting out
ANNEX 6: SHORT-CUT PLANNING AND BUDGETING

WHEN STARTING OUT
Perhaps you:
◆ have a small health facility
◆ are short of managers or management skills

◆ have limited or no technical staff
◆ cannot cope with this whole Guide yet.
If so, you may want to try a shortened version of planning and budgeting for equipment. Box 57 shows
the bare minimum requirements you need to put in place when you are first starting out.
It assumes you will not be undertaking long-term forward planning, but will initially concentrate on
planning and budgeting on a yearly basis. As you progress, you can add in the other elements for
forward planning.
BOX 57: Bare Minimum Planning and Budgeting Requirements

Planning and budgeting element If you are just starting out
◆ Equipment inventory (Section 3.1) ◆ essential to have
◆ Stock value estimates (Section 3.2) ◆ useful to carry out this exercise later on when you
need rough estimates for long-term forward planning
◆ Budget lines for equipment expenditures ◆ this alteration to your budget layout can be done
(Section 3.3) later, but it will help with analysis
◆ Usage rates for equipment-related ◆ useful to do this exercise as it helps you calculate
consumable items (Section 3.4) specific (annual) estimates
◆ Reference materials (Section 4.1) ◆ these can be developed over time
◆ Developing the Vision of service delivery ◆ you should have an understanding of this, even if
for each facility type (Section 4.2) you do not undertake a full exercise
◆ Model Equipment Lists (Section 4.3) ◆ initially, use a list of urgent equipment needs drawn
up by departments. Later on, learn from other
people’s Model Equipment Lists
◆ Purchasing, donations, replacement, and ◆ essential to have
disposal policies (Section 4.4)
◆ Generic equipment specifications and ◆ initially learn from others. Later, develop your own
technical data (Section 4.5)
◆ Capital budget calculations (Section 5) ◆ initially learn how to make specific (annual)
estimates; only learn the rough estimation methods
when undertaking long-term planning
◆ Recurrent budget calculations (Section 6) ◆ initially learn how to make specific (annual)
estimates. Only learn the rough estimation methods
when undertaking long-term planning
◆ Equipment development plan (Section 7.1) ◆ use the basic equipment development planning
process only, and only apply it to the short-term
◆ Equipment training plan (Section 7.2) ◆ develop a straightforward one for the short-term
◆ Core equipment expenditure plan ◆ initially only plan annually (see below)
(Section 7.3.1)
◆ Core equipment financing plan ◆ initially only plan annually (see below)
(Section 7.3.2)
◆ Annual equipment planning and budgeting ◆ create annual actions plans and an equipment budget
(Section 8.1) showing income and expenditure
◆ Monitoring progress (Section 8.2) ◆ undertake the basic elements only – progress with
annual plans and tools, coping with emergencies,
providing feedback.
279
Annex 6: Short-cut planning and budgeting when starting out
Figure 38 shows the suggested steps for a shortened version of planning and budgeting for equipment.
Figure 38: Shortened Version of Planning and Budgeting

People
Steps Activity
Responsible
Establish your equipment HTM Team Use Box 7 (Section 3.1)

inventory
Undertake the exercise to HTM Working

calculate your consumable Group Use Figure 10 (Section 3.4)
usage rates (HTMWG)
Ensure you understand what Health Write down your health delivery goals and your place in
the vision is for your facility Management the health service. For the technology implications of your
Team vision, ask yourself the questions in Box 15 (Section 4.2)
Gather departmental requests of urgent needs for

Use a substitute for a model replacement and new equipment. In time, try to obtain
equipment list HTMWG other peoples’ model equipment lists to learn from
(Section 4.3).
Develop your purchasing, Health

donations, replacement, and Try to follow the advice in Boxes 17–19 (Section 4.4) and
Management
disposal policies apply them to the departmental requests for equipment
Team
Try not to fall into the typical traps when specifying

Develop basic generic equipment (Section 4.5). Learn from other people’s
equipment specifications and HTMWG specifications. Write simple specifications as you need
a technical data sheet them (see Figure 11), and a simple technical data sheet
(see Figure 12).
Ensure you understand how to

make capital budget See Boxes 24 and 25 (Section 5.2), Figures 15 – 18
calculations for specific HTMWG
(Sections 5.3 – 5.5)
(annual) estimates.
Ensure you understand how to

make recurrent budget See Box 29 (Section 6.1) and Figures 21– 24
HTMWG
calculations for specific (Sections 6.1 – 6.4)
(annual) estimates.
Use the basic equipment

development planning process, HTMWG Use Figure 25 (Section 7.1), but for the short-term only
for the short term
Create a basic equipment

training plan, for the short term HTMWG Use Figure 27 (Section 7.2), but for the short-term only
Each year follow the annual

process HTMWG Use relevant parts of Figures 31 – 37 (Section 8.1)
Develop expenditure and

income requirements each year HTMWG Use Box 47 (Section 8.1)
Monitor progress HTMWG Use the basic elements of Section 8.2
280
Annex 7: Source material/bibliography
ANNEX 7: SOURCE MATERIAL/BIBLIOGRAPHY

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‘How to Manage’ Series for Healthcare Technology

How to Plan and Budget for your

List of Boxes and Figures vii

3. How to Discover your Starting Point – Planning Tools I 41

4. How to Find Out Where You are Headed – Planning Tools II 65

5. How to Make Capital Budget Calculations

5.2 Purchasing New Equipment 106

6. How to Make Recurrent Budget Calculations

7. How to Use the Tools to Make Long-term Equipment Plans

8. How to Undertake Annual Planning, Budgeting,

This Series of Guides aims to promote better management of healthcare technology

Andrei Issakov, Coordinator, Health Technology and Facilities Planning and

Mladen Poluta, Director, UCT/WHO HTM Programme, University of Cape

◆ with specialist support from:

◆ with assistance from an Advisory Group of:

Peter Heimann, Director, WHO Collaborating Centre for Essential Health

Antonio Hernandez, Regional Advisor, Health Services Engineering and Maintenance,

Andrei Issakov, Coordinator, Health Technology and Facilities Planning and

Yunkap Kwankam, Scientist, Department of Health Service Provision,WHO,

◆ and reviewed by:

Tsibu J. Bbuku, Medical Equipment Specialist, Central Board of Health,

Juliette Cook, Biomedical Engineer, Advisor to Ministries of Health of Mozambique,

Peter Cook, Biomedical Engineer, ECHO International Health Services,

Trond Fagerli, Senior Advisor, Haraldsplass Deaconal Hospital, Bergen, Norway

Freedom Dellosa, Chief of Hospital Equipment Maintenance Service Division,

Roland Fritz, HCTS Coordinator, Christian Social Services Commission, Dar es

Andrew Gammie, Project Director, International Nepal Fellowship, Pokhara, Nepal

Muditha Jayatilaka, Deputy Director General of Health Services (Biomedical

Dyness Kasungami, District Director of Health – Kafue DHMT/Reproductive

Godfrey Katabaro, Biomedical Engineering Technologist, Kagera Medical Technical

Sulaiman Shahabuddin, Director, Patient Services, Aga Khan Foundation Private

Khout Thavary, Chief of Financial Planning Office, Ministry of Health,

Birgit Thiede, Physical Assets Management (PAM) Advisor, Ministry of Health,

Dr K. Upadhyaya, Medical Superintendent, Western Regional Hospital,

◆ using source material:

◆ with financial assistance from:

◆ with administrative support from:

ACA annual corrective activities

PPM planned preventive maintenance

List of Boxes and Figures

Box 27: Suggestions for rough estimations of large-scale major

Box 54: Summary of procedures in Section 8 on setting annual goals and

Figure 1: The place of HTM in the health system 2

Figure 23: How to make specific estimates of assorted equipment-related

Why is This Important?

◆ the people the Guides are aimed at

1.1 INTRODUCTION TO THE SERIES OF GUIDES

◆ is used correctly and to maximum capacity

Such effective and appropriate management of healthcare technology will contribute

Figure 1: The Place of Healthcare Technology Management in the Health System

Health Sector Organization

Human Resources Healthy

What Do we Mean by Healthcare Technology?

BOX 1: Categories of Equipment and Technologies Described as ‘Healthcare Technology’

medical equipment walking aids health facility furniture

For examples of these different categories, see the Glossary in Annex 1.

Often, different types of equipment and technologies are the responsibility of

What is Healthcare Technology Management?

This Series of Guides provides advice on a wide range of management procedures,

Box 2 highlights some of the benefits of HTM.

BOX 2: Benefits of Healthcare Technology Management (HTM)

Purpose of the Series of Guides

◆ a non-governmental organization (NGO) (such as a charitable or